Provider Training

All provider training is currently on hold. Previously we had indicated to some providers that it would be held during the month of July, but those plans have changed. If you have specific questions or needs, please contact the Provider Relations Department to discuss.

Billing Update

Updated List of Codes

There have been code changes since the crosswalk to new HIPAA compliant codes was provided in February 2004. Please refer to the new code listing for a comprehensive list of CPT/HCPCS codes allowable under the Public Mental Health System.

The codes have been arranged by type of provider, payment amount allowed, and code. Please review to assure that you are following the latest codes.

New Codes

The following two codes have been replaced effective July 1, 2004. Please change your billing accordingly.

S0201 has replaced H0035 Mental Health Partial hospitalization—This code is reserved for use by the Freestanding Partial Hospitalization Programs approved by the State MA Program. Rate is $182.00.
S0201-52 Intensive Outpatient Program—This code also is reserved for use by Freestanding Partial Hospitalization Programs. Rate is $99.00.
H0031 has replaced H0002-HK Behavioral Health Screening—This code is only to be used by approved programs.
Clarification on PRP Code:

Transitioning PRP Services from Hospital to Community—Providers should use H2018-U3, POS 15 (off-site). There is a minimum requirement of 4 encounters in order to bill this code. The reimbursement rate is $400.

Partial Hospitalization and Intensive Outpatient Programs

Freestanding PHP’s approved by the State MA Program are entitled to bill:

S0201 Partial Hospitalization Program
S0201-52 Intensive IOP
OMHC’s are entitled to bill:

S9480 Intensive Outpatient Psychiatric Services (Clinic Model)
Block 32, HCFA 1500, Name & Address of Facility Where Services Were Rendered

Please remember to include the name, address, and MA # of the facility where services were rendered if the place of service is other than an office or home. Please check this link if you need the numbers.

Clinical Update

Authorizations are required for Partial Hospitalization and Intensive Outpatient Programs. Please follow these guidelines when requesting them.

Partial Hospitalization—MAPS-MD requires all Medicaid-insured consumers to be pre-certified for partial hospitalization. MAPS-MD does not pre-certify non-Medicaid insured (gray zone) consumers being seen at an HSCRC Hospital or Medicare consumers with or without Medical Assistance. The Public Mental Health System no longer covers outpatient services at HSCRC hospitals and Medicare covers partial hospitalization, so no authorizations are required for those two categories.

Intensive Outpatient Program—MAPS-MD will not pre-certify non-Medicaid insured consumers being seen at an HSCRC Hospital. MAPS-MD will pre-certify Medicare consumers because this is not a covered benefit under the federal program.