Attention Behavioral Health Providers:

Transcription

1 To view this as a web page, go here. 7/10/17 Medicaid Website Manuals & Bulletins Fee Schedules What's New Links IVR Navigation Tips Web Portal Tutorials Attention Behavioral Health Providers: In an effort to standardize billing for all behavioral health providers, some codes will be discontinued. Effective August 1 st, 17, the following codes will be consolidated to streamline and simplify billing for Community Mental Health and Substance Abuse Treatment Centers, as well as other behavioral health individual and group practices. The following HCPCS codes will be discontinued: T1007 H21 H0047 T1012 H0034 H0005 H15 H0006 Alcohol/Drug Services - Treatment Plan Development and Modifications Community-Based Individual/Family Therapy Alcohol/Drug Services - NOS, Community Based Individual/Family Therapy Alcohol/Drug Services - Skill Development (Psychosocial Rehab Services) Comprehensive Medication Service - Medication Training and Support Alcohol/Drug Services - Group Counseling by Clinician Comprehensive Community Support Services - Individual Rehab Services Alcohol/Drug Services - Case Management Service Description Current HCPCS Consolidated HCPCS Individual/Family Therapy Agency-based: Individual Therapy: H19 - MH T SA Community-based: H19, with modifier TN if performed in a community -based setting H21 - MH H SA Family Therapy: H0004 Day-treatment/ psychosocial rehab H17 - MH H17

2 Comprehensive Medication Services Group Therapy T SA H MH H10 - SA H19+HQ - MH H10 H19+HQ Individual rehabilitation H SA H14 - MH H14 Certified peer specialist H15 - SA H14+HH - MH H0038 Case management H15+HH - SA T MH H006 - SA T1017, Targeted Case Management for Adults (21 and over) G9012, Ongoing Case Management for Children (under 21) The only modifiers that will be allowed for the behavioral health HCPCS codes are the following: Behavioral Health Modifiers Modifier(s) UK TN HQ Description Services on behalf of the client- Collateral Contact Community-Based Setting; Rural/outside providers' customary service area Group setting Community-based services are services that are provided to a client in their home or community rather than in institutions or other isolated settings. Community-based services should not be billed to Medicaid if the therapy is scheduled in the community for the convenience of the provider or client. The community-based services need to be related to a goal or objective in the treatment plan. To bill Community-based services, please use the code and the new modifier TN after the code. There is an important policy distinction between an agency based service and a community based service. Agency based services are provided in a clinic or office setting. Community based services are provided outside of the provider's office or agency and in a client's community. There are exceptions to these service definitions. If a provider has a contract/agreement/employment arrangement to provide services to clients elsewhere (i.e. in a nursing home, hospital, residential treatment center, etc.), those services are still considered to be agency based services rather than community based services - institutions are not considered to be community settings. These alternate service locations are considered to be an extension of, or additional place of business, for agency based providers. For example, if a provider has an agreement with a nursing home to provide therapy services and travels from their agency to the nursing home, these services should still be considered agency based services and are required to be billed as such. A second example would be if an agency based provider travels to a residential treatment center and conducts assessments and therapy sessions. These services would be considered agency based services. Services provided under

3 an agreement with another state agency (i.e. DFS) are also considered to be an extension of agency based services as well under Medicaid policy. Reminder If you missed the July 1st Bulletin on coding changes, please see below for a brief description or look for the bulletin at under the tab Provider Manuals and Bulletins, Mental Health and Substance Abuse Treatment Centers. The bulletin is called Family Therapy and Collateral Contact Bulletin. Collateral Contact As per the Wyoming Medicaid Rules, Chapter 13 - Mental Health Services, it states the following: "Collateral contact." An individual involved in the client's care. This individual may be a family member, guardian, healthcare professional or person who is a knowledgeable source of information about the client's situation and serves to support or corroborate information provided by the client. The individual contributes a direct and an exclusive benefit for the covered client. Starting date of service July 1st, 17, procedure modifier UK - Services provided on behalf of the client to someone other than the client (collateral relationship) will be used to identify these claims. The only codes that are allowed with the Collateral Modifier (UK) are the following: HCPCS Codes Description G9012 Ongoing Case Management T1017 Targeted Case Management H0004 Family Therapy H0031 Clinical Assessment H0038 Peer Specialist Service H19 Individual Therapy H19 HQ Group Therapy Examples of determining codes and modifiers: Is it an agency based or community based services? Is the service with a collateral contact, individual or family? Which modifier(s) do I add to my claim?

4 New Family Therapy Code - H0004 Starting July 1st, 17, the new Family Therapy Code will be H Behavioral Health Counseling and Therapy, per 15 minutes. This code, H0004 will be added so that H19 will only be used for Individual Therapy. Please note that if you use the Current Procedural Terminology (CPT) codes such as 90832, 90834, Psychotherapy or Family psychotherapy, you can continue to use them. The CMS 1500 Provider Manual for Wyoming Medicaid, Chapter 13 - Behavioral Health Services will have an updated chart that will be published October 1st. Please see below for the updates. It won't be published until October 1st. The definitions of behavioral health services (mental health/substance abuse) for Wyoming Medicaid can be found in the CMS 1500 Provider Manual. HCPCS Level II Code G9012 T1017 Description Ongoing Case Management 1 Unit Equals Per 15 minutes Pay-to Providers Allowed Adult Case Management - Per 15 Targeted Case Management minutes (>21) Treating Allowed 101Y00000X 171M00000X, 101Y00000X

5 H0004 H0031 H0038 H0038+HQ H10 H14 Family Therapy Clinical Assessment - Mental Health Assessment by non-physician Certified Peer Specialist Certified Peer Specialist with a group Comprehensive Medication Therapy Individual Rehabilitative Service - Skills Training and Development Per 15 minutes Per 15 minutes Per QM0801X minutes Per QM0801X minutes Per QM0801X minutes Per QM0801X minutes 171M00000X, 172V00000X 172V00000X 164W00000X, 171M00000X, 172V00000X

6 164W00000X, 171M00000X, 172V00000X H17 Psychosocial Rehabilitation Services Per QM0801X minutes 171M00000X, 364SP0808X H19 Agency Based Individual Therapy Per 15 minutes H19+HQ Group Therapy - Group Counseling by Clinician Per 15 minutes T11 PASRR Level II Psychiatric Evaluation/Determination of Appropriate Placement

7 CPT Code Description Interactive complexity (list separately in addition to the code for primary procedure) Psychiatric Diagnostic Evaluation Psychiatric diagnostic evaluation with medical services Psychotherapy, 30 minutes with patient and/or family member 1 Unit Equals 261QM0801X Pay-to Providers Allowed, Treating Allowed (Physicians) (Physicians)

8 Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) Psychotherapy, 45 minutes with patient and/or family member Psychotherapy, 45-minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) Psychotherapy, 60 minutes with patient and/or family member Psychotherapy, 60 minutes with patient and/or., (Physicians) (Physicians) (Physicians)

9 family member when performed with an evaluation and management services (list separately in addition to the code for primary procedure) Psychoanalysis Family Medical Psychotherapy (without the patient present) Family Psychotherapy Multiple-Family Group Psychotherapy,, 101YA0400X (Physicians) (Physicians)

10 90853 Group Medical Psychotherapy 101YA0400X , 96105, , 96116, , Central Nervous System Assessments/Psychological Testing Community Mental Health Centers & Substance Abuse Treatment Centers Taxonomy Provider Types Allowed Codes 101Y00000X 101YA0400X 101YP2500X Provisional Professional Counselor (PPC) Certified Mental Health Worker Licensed Addictions Therapist (LAT), Provisionally Licensed Addiction Therapist (PLAT), Certified Addictions Practitioner (CAP) Licensed Professional Counselor (LPC) G9012, H0004, H0031, H14, H17, H17, H19, H19 + HQ, T1017, T11, 90785, 90791, 90832,90834, 90837, 90845, 90847, 90849, G9012, H0004, H0031, H14, H17, H19, H19 + HQ, T1017, T11, 90785, 90791, 90832, 90834,90837, 90845, 90847, 90849, G9012, H0004, H0031, H10, H14, H17, H19, H19 + HQ, T1017,90791, 90785, 90832, 90834, 90837, 90846, 90847, 90849, 90853

11 103G00000X 103TC0700X 1041C0700X 106H00000X 163W00000X Neuropsychologist Clinical Psychologist Licensed Clinical Social Worker (LCSW), Certified Social Worker (CSW) Marriage and Family Therapist (MFT), Provisionally Licensed Marriage and Family Therapist (PMFT) RN G9012, H0004, H0031, H14, H17, H19, H19 + HQ,T1017, T11, 90785, 90791, 90792, , , ,90849, 90853, , 96105, , 96116, , G9012, H0004, H0031, H14, H17, H19, H19 + HQ, T1017, T11, 90785, 90791, 90792, , , ,90849, 90853, , 96105, , 96116, , G9012, H0004, H0031, H14, H17, H19, H19 + HQ, T1017, T11, 90785, 90791, 90832, 90834,90837, G9012, H0004, H0031, H14, H17, H19, H19 + HQ, T1017, T11, 90785, 90791, 90832, 90834,90837, 90845, 90849, G9012, H0004, H0031, H10, H14, H17, H19, T W00000X LPN G9012, H10, H14 171M00000X Case Manager G9012, H14, H17, T V00000X Certified Peer Specialist H V00000X 84P0800X 364SP0808X Community Health Worker - Individual Rehabilitative Services Worker (IRS), Certified Addictions Practitioner Assistant (CAPA) Physicians Psychiatry and Neurology, Psychiatry Nurse Practitioner, Advanced Practice, Psychiatric/Mental Health H14 G9012, H0004, H0031, H19, H19 + HQ, T1017, 90785, 90791, 90792, , , , 90847, 90849, 90853, ,96105, , 96116, , G9012, H0004, H0031, H17, H19,H19 + HQ, T1017, T11, 90785, 90791, 90792, , , , 90849, 90853, , 96105, , 96116, ,96125 G9012, H0004, H0031, H10, H17, T1017, T11, 90785, 90791, 90792, , , , 90849, 90853, , 96105, , 96116, , 96125

12 For questions, please contact Brenda Stout, Medicaid Behavioral Health Manager at Help identify and combat Medicaid Fraud by visiting the website or contacting the Fraud Hotline: WYhealth is a Medicaid health management and utilization management program offered by the Wyoming Department of Health through Optum. Medicaid clients and providers will benefit from a wide array of programs and services offered and coordinated by Optum. Visit for more information Unsubscribe Be sure to add wycustomersvc@conduent.com to your address book to ensure the proper delivery of your Wyoming Medicaid updates and weekly payment summary information. Wyoming Medicaid, Provider Relations, PO Box 667, Cheyenne, WY 803 Please do not reply to this with any customer service issues. Specific account inquiries will not be read. For assistance, contact Provider Relations at Deployment: Date: 7/14/17 Time: 10am MST Audience: Mental Health Providers