Billing Clarification

MHA has provided the following billing clarification to individual providers, group practices, and OMHC’s, which are effective immediately. Please click on the appropriate links for your type of organization.

Consumer Survey

The 2003 Consumer Survey is now posted in the Survey and Reports section of the website. Check it out and find out what the consumers think of the services being provided by the Public Mental Health System.

Billing Update

Correct Coding

MAPS-MD has noted incorrect coding on the part of some providers and will be making retractions as appropriate. Please note:

• 90846 (Family Therapy without Patient) and 90847 (Family Therapy with Patient)--Only one of these codes should be billed per consumer per day. If more than one is billed, payment will be retracted.
• 90805, 90807, 90809 (Individual Psychotherapy with Medical Evaluation and Management)--These codes should not be billed with 90862 since medical management is incorporated into the codes set forth above. These codes can only be billed by an M.D.

90801 and V71.09

A provider may perform a 90801 service for a consumer and determine that the consumer does not have a mental condition and that he or she does not require ongoing treatment. Providers may submit claims with a diagnosis of V71.09, Observation for Other Suspected Medical Condition. Only one 90801 is allowed per consumer, per provider, per anniversary year (i.e., one year after the most recent diagnostic interview).

EPSDT One-on-One Behavioral Aide

Code 96152 (formerly code W9115) for EPSDT One-on-One Behavioral Services is replaced with code H2019 effective May 1, 2004. (As of May 1, 2004, you may only bill 96152 to Maryland Medical Assistance for children whose main diagnosis is not a specialty mental health condition).

PRP Clarification

• H2016 Pass Through—Your encounter (H2016) has passed the MAPS-MD edits as meeting the billing threshold if you receive an EOP with an EX code of either 45, UZ, or 90. Except for the U2 level, MAPS-MD will count the H2016 as acceptable if the PRP bills both the off-site and on-site on the same day. When billing, you should indicate H2016, POS 15, and H2016, POS 52. The code will deny as a duplicate with EX 45, but MAPS-MD will count it as acceptable.
• EOP’s and H2016—You cannot tell from the EOP what Place of Service code has been processed if you submit 2 H2016’s for the same date of service. Suggestion: Submit H2016, POS 15 with $1.00 charge and H2016, POS 52 with a $2.00 charge and you can track the different code by the dollar amount.

S5150-Enhanced Client Supervision

MAPS-MD’s system was not correctly accounting for the number of units submitted on the claims. We will reprocess the claims as soon as possible. The provider does not need to do anything. If you have not received corrected payment by May 1, 2004, please contact Provider Relations.

Clinical Update

The authorizations going to PRP providers now have the location and procedure modifier codes both on the letters and on the website, www.gzmd.com. This change was made based upon provider input to MAPS-MD so we hope that it assists you in completing accurate bills.

APS healthcareProvider Website

We have announced this website in numerous editions of the Web Issues Bulletin and have not had strong provider interest in signing up.

If you are currently using www.gzmd.com to obtain authorizations, you need to get access to the APS healthcare Health website (http://www.apshealthcare.com) as the former website will be coming down and the authorizations will be on the latter website in the future.

MAPS-MD ultimately expects to consolidate all its information from www.MAPS-MD.com on the APS healthcare Health website as well.

So please pull up the provider agreement in the Forms section. Review the agreement, sign the application and forward to the St. Louis address. One application is needed per tax id number. By signing up today, you have current access to claims inquiry, non-Medicaid insured (gray zone) eligibility, and Claims Courier (direct data entry of HCFA-1500’s) to MAPS-MD.

If all of this confuses you, please call Provider Relations at 410-953-1836 so you can discuss the website and the signing up process. If you have signed up and are confused regarding how to navigate the website, please call us.

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