The documentation must summarize the purpose and content of the services, along with specific strategies and activities utilized as related to the goal(s) in the clients plan of care. Effective for dates of service on or after January 1, 2019, peer specialist services will become a benefit for Texas Medicaid. Despite legislative requirements the Office of Inspector General OIG reported that the Centers for Medicare 38 Medicaid Services New technology calls for an abundance of inpatient code changes. An official website of the United States government Code Validity. SUD-MOUD may include: Providers are encouraged to verify member eligibility in MNITS on a monthly basis. means youve safely connected to the .gov website. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to services billed on the UB-04 claim form and to electronic claim submissions (i.e., 837p and 837i) and for claims submitted online through provider portals. The date that a record was last updated or changed. Minnesota Statutes, 256B.031 (Prepaid Health Plans) June 15, 2023, Reminder: Invoices for Non-UCR Federal and State Allocations Due June 5, Quality Management and Corporate Compliance, Applicable Laws and Regulations for Regulatory Compliance, Licensed Independent Practitioner Collaborative, Resources & Training for Tailored Plan Tobacco Free Initiative, Tailored Plan Good Faith Contracting Efforts Policy, Partners Medicaid Provider Contract Templates, Partners Health Management Area Authority/BH/IDD Tailored Plan Contract, Provider Alert: Invoices for Non-UCR Federal and State Allocations Due June 5, Provider Alert: Change in How Providers Access ProAuth, Provider Alert: ILOS Changes Updated April 6, 2023, Provider Alert: ILOS Changes Effective April 1, 2023, Access to Care and Utilization Management, Universal Child Residential Placement Application, Partners State-funded Service Request & Waiting List Form, Access to Care, Member Eligibility and Enrollment, Mental Health and Substance Use Disorders, Transitions to Community Living Initative, Intellectual and Developmental Disabilities, State-funded Service Eligibility and Enrollment Information for providers serving members affected by County Realignment, Utilization Management Information for providers serving members affected by County Realignment, Provider Alert: Local Administrators Must Set Up General Users in ProviderCONNECT. If you do not agree to the terms and conditions, you may not access or use the software. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. Outpatient 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government. Bill all nonresidential (outpatient) SUD-MOUD using the professional (837P) claim format. Self-help/peer services, per 15 minutes. Resources: All rights reserved. Code used to identify the appropriate methodology for . Mental health rehabilitative services are billed separately from peer specialist services. Include the date of discharge on the final treatment claim along with appropriate patient status code. All rights reserved. Scope: Products included: Fully Integrated Dual Eligible (FIDE)-SNP Managed Long-Term Services and Supports (MLTSS) Division of Developmentally Disabled (DDD) Definitions: Procedure Code H0038: Self-help/peer services, per 15 minutes Provider Communication Bulletin #141 - June 15, 2023. IF YOU DO NO AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. Code used to identify instances where a procedure Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept". The terms of any applicable provider participation agreement; Routine claim editing logic, including but not limited to incidental or mutually exclusive logic; Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services. <> The ADA does no t directly or indirectly practice medicine or dispense dental services. Bill treatment services to the plan and bill room and board to MHCP as follows: Billing Freestanding and Residential Program Room-and-Board Charges Secure .gov websites use HTTPSA H0039. The federal mandate will end but employers may still require vaccination. Below you will find the Code List that is effective January 1, 2023 and a description of the revisions effective for Calendar Year 2023. Official websites use .govA Or, if you would like to remain in the current site, click Cancel. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". may have one to four pricing codes. These codes have an E1 status: The answer would be no. The carrier assigned CMS type of service which parenteral and enteral nutrients, equipment and supplies; prosthetics, orthotics, and prosthetic devices and supplies; inpatient and outpatient hospital services. Behavioral Health Utilization Management Authorization Guidelines ***Prior to reviewing the guidelines below, please review the latest bulletin related to the Federal Public Health Emergency Special Bulletin COVID-19 #265. represented by the procedure code. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. See the BHF Service Rate Grid with Dollar Amounts (DHS-7612) (PDF) for covered services and complexity add-on rates. Providers must be enrolled with MHCP as an eligible provider of specific services, specialties or complexity add-ons to receive reimbursement from MHCP. Alcohol and Drug Abuse Treatment H0001-H2037. Services must be rendered to those individuals in need of support to maintain stability in the community with a substance use disorder. Bill residential and inpatient hospital claims that span multiple months using interim billing method. Providers must enroll and participate in the Drug and Alcohol Abuse Normative Evaluation System (DAANES). If an MD is providing services of H0038 or 90832, Kentucky MCO's are denying as non covered. Inpatient hospital bundled room and board and treatment, Inpatient hospital room-and-board component only, Inpatient hospital treatment component only, Residential program room-and-board component only, Residential program treatment component only, Nonresidential (outpatient) individual treatment, Nonresidential (outpatient) group treatment, Nonresidential (outpatient) treatment SUD-MOUD (Methadone), Nonresidential (outpatient) treatment SUD-MOUD (Methadone-Plus), Nonresidential (outpatient) treatment SUD-MOUD (Other), Nonresidential (outpatient) treatment SUD-MOUD (Other-Plus). Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Apply today! $3.56 per unit * The Department of Medicaid Services (DMS) encourages all providers to consult with a Certified Professional Coder regarding billing codes and other issues. stream Certification must be renewed every two years, including any required continuing education hours. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. Breaks may not be included in these continuous minutes. Certified Medicare facilities serving Medicare-eligible clients must follow the MHCP Medicare policy found in the MHCP Provider Manual; see Medicare and Other Insurance under Billing Policy. Eligible providers may include the following: A provider seeking to enroll in the 1115 SUD Reform Demonstration must be enrolled as an MHCP provider for Substance Use Disorder (SUD) Services. Providers should refer to current national coding and billing manuals for information on valid code sets. meaningful groupings of procedures and services. Some hospitals and coding and billing entities are under the impression that the new Alcohol and Drug Abuse Treatment H0001-H2037, Mental Health Programs and Medication Administration Training H0031-H0040, Copyright 2023. We are an outpatient mental health facility. A peer specialist supervisor must successfully complete supervisory training on peer specialist services and the recovery model from a certified training entity before supervising a peer specialist. * Tobacco Use Disorder cessation when provided as counseling by an alcohol and drug counselor and indicated as needed on a treatment plan can be provided in an individual or group counseling session (H2035 or H2035 HQ). H0038: The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. Retrospective review may be performed to ensure documentation supports the medical necessity of the requested service. You can contact us through our Provider Support Line at1-866-990-9712 with any questions. A peer specialist uses his or her lived experience to support a client in achieving goals and objectives in the clients person-centered recovery plan, as well as skill development, problem solving strategies, and coping mechanisms for stressors and barriers encountered when recovering from a mental health condition or a substance use disorder. ), NC Medicaid Community Behavioral Health Taxonomy 251S00000X Provider Attestation Form, North Carolina Department of Health and Human Services, Provider Policies, Manuals, Guidelines and Forms. You will not receive reimbursment as a SUD treatment provider unless you have complied with the DAANES requirements for each Behavioral Health Fund (BHF) recipient. General Background Peer Support Services HCPCS. Minnesota Statutes, 256L (MinnesotaCare), Minnesota Rules, 9530.6800 to 9530.7030 (Rule 24) beneficiaries and to individuals enrolled in private health products and services which may be provided to Medicare A code denoting Medicare coverage status. lock The codes are divided into two levels, or groups, as described Below: Level I Codes and . Minnesota Statutes, 256B.0759 (Substance Use Disorder Demonstration) All rights reserved. You are using an out of date browser. Beginning with the Code List effective January 1, 2023, updates are published solely on this webpage. Individuals with private insurance may qualify for behavioral health fund if their insurance does not cover 100 percent of their treatment. (28 characters or less). CMS DISCLAIMER. If no comments are received, in lieu of a comment response, we will publish a note below the applicable Code List year stating so. A QCC or LPHA supervising a QMHP or QPS must provide individual or group supervision at least once a month, and conduct an observation of the QMHP or QPS conducting peer specialist supervision at a frequency determined by the QCC or LPHA, based on the QMHPs or QPSs skill level. H0038 HQ Self-help/Peer Services, individual, per 15 minutes - Requires HF modifier. 2. procedure code based on generally agreed upon clinically Coupled with applicable federal and state rules, regulations, clinical coverage policies and other guidance, Vaya Health uses the authorization guidelines in making decisions about requests for authorization. 4 0 obj E1 is used for items and services that are: -Not covered by any Medicare outpatient benefit category EPO and other dialysis-related drugs (42 CFR 411.355(g)), Preventive screening tests and vaccines (42 CFR 411.355(h)), Self-Referral Disclosure Protocol Settlements, List of codes effective January 1, 2022, published November 19, 2021, List of codes effective January 1, 2021, issued December 1, 2020, List of codes effective January 1, 2020, published December 2, 2019, List of codes effective January 1, 2019, published November 23, 2018, List of codes effective January 1, 2018, published November 3, 2017 [ZIP, 59KB], List of codes effective January 1, 2017, published November 16, 2016 [ZIP, 54KB], List of codes effective January 1, 2016, published October 30, 2015 [ZIP, 58KB], List of codes effective January 1, 2015, published November 13, 2014 (79 FR 67972) [ZIP, 54KB], List of codes effective January 1, 2014, published December 10, 2013 (78 FR 74791) [ZIP, 54KB], List of codes effective January 1, 2013, published November 16, 2012 (77 FR 69334) [ZIP, 54KB], List of codes effective January 1, 2012, published November 28, 2011 (76 FR 73438-73440) [ZIP, 51KB]. The code is defined as alcohol and/or drug counseling per hour. The code is defined by a unit of time. $10.00 $40.00 Modifer HQ (group setting) HSD (High school diploma) Reimbursement and Coding Summary HCPCS Code Modifier r l. t Description Rate Per Youth Supprt and Training 1 of 1. Bill freestanding or residential program room-and-board charges (revenue codes 1003 or 1002) that are authorized by the MCO directly to MHCP. Providers are encouraged to verify member eligibility in MNITS on a monthly basis. We bill this to Medicaid and are paid per unit. We are looking for some coding guidance for addiction services in Kentucky. H0038 HSD Ind. All SUD clients regardless of funding need to be entered into DAANES for each admission episode. Codes. In order to be reimbursed, the claim must include an applicable substance disorder diagnosis code. Peer specialist supervision must be provided by one of the following: Peer specialist supervision must focus on a peer specialists provision of services, including review of cases and activities, skill building, problem resolution, and professional growth. Report the appropriate place of service to distinguish on-site dosages from take-home dosages. We received one (1) comment related to the supervision level required for specific services. developing unique pricing amounts under part B. The following policies, manuals, guidelines, and forms are intended to assist providers in billing for services covered under one or more of the NC DHHS divisions supported by NCTracks. See exceptions in the SUD Withdrawal Management Services section of the MHCP Provider Manual. Procedure code H0038 must be submitted with one of the following modifiers to identify the specialty focus: If services are provided in a group setting, procedure code H0038 must also be submitted with modifier HQ. Bill residential and inpatient hospital claims that span multiple months using interim billing method. This Agreement will terminate upon notice if you violate its terms. Upon completion of the core training, supplemental training in one of the two following specialty areas must be completed: A person may apply for initial certification after successful completion of core and supplemental training and a knowledge assessment. Subcontracted peer specialist services must also be part of the coordinated, comprehensive, and individualized person-centered recovery plan. This reimbursement policy applies to all health care services billed on CMS 1500 . The ADA is a third party beneficiary to this Agreement. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials. HCPCS Code H0038 Self-help/peer services, per 15 minutes Alcohol and Drug Abuse Treatment Services / Rehabilitative Services H0038 is a valid 2023 HCPCS code for Self-help/peer services, per 15 minutes or just " Self-help/peer svc per 15min " for short, used in Other medical items or services . These codes have an E1 status: "Both E1 and E2 are not paid by Medicare when submitted on outpatient claims (any outpatient bill type). WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. or NOTE - Taxonomy information can be found on the Provider User Guides and Training page, Currently Enrolled Provider (CEP) Registration, Provider Re-credentialing/Re-verification, New Medicare Card Project (formerly SSNRI), Medicaid Direct Tailored Care Management Provider Claims Billing Guidance, Provider Claims and Billing Assistance Guide, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), EOB Code Crosswalk to HIPAA Standard Codes, Medicaid and NCHC Clinical Coverage Policies, NCTracks Benefit Plans Mapped to DHB Eligibility Coverage Codes, NCTracks Benefit Plans Not Mapped to DHB Eligibility Coverage Codes, LME MCO Manual for Encounter Data Submission, Prepaid Inpatient Health Plan Encounter Edit Manual, Instructions for Federal Sterilization Consent Form, Instructions for Filling Out a Hysterectomy Statement, NC Medicaid Non-Emergency Medical Transportation (NEMT) Provider/Broker Attestation Form, NCTracks Provider Refund Form Instructions, Out-of-State Durable Medical Equipment (DME) Provider Form, Reproductive Health Forms (Hysterectomy Statement, Sterilization Consent Form, etc. HCPCS Codes. Reminder: Invoices for Non-UCR Federal and State Allocations Due June 5 - I had a question about denials that we are getting from Buckeye. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. website belongs to an official government organization in the United States. Critical treatment junctures: Effective November 1, 2020: 1. Service limit of eight (8) person per group. endobj After completing the required internship hours, initially certified peer specialists may apply for renewed certification through the approved certified body. The Medicaid-enrolled provider must ensure proper documentation of all peer specialist services delivered. The demonstration, through the implementation of ASAM criteria, seeks to enhance evidence-based assessment and placement criteria for the purpose of matching individual risk with the appropriate ASAM level of care. CPT Copyright 2017 American Medical Association. After approval, the effective date of the providers participation will be determined by the Minnesota Department of Human Services (DHS) based on when the Approval to Enroll letter was issued. Coupled with applicable federal and state rules, regulations, clinical coverage policies and other guidance, Vaya Health uses the authorization guidelines in making decisions about requests for authorization. activities except time. % T1017 (Targeted Case Management) and H0038 (Peer Support) are not billable to Medicare, right? We update the Code List to conform to the most recent publications of CPT and HCPCS codes and to account for changes in Medicare coverage and payment policies. Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Subscribers see the ICD-10-CM codes a contractor allows and full LCD policy text on the same website. Initial request for Outpatient Mental Health (OMH) and Rehabilitative Mental Health (RMH) services: Submit no more than 15 business days before and no more than 15 calendar days after the start date of service, unless otherwise specified for a service in the Billing Guide or in the Billing Manual. 4. Place of Service; 02: Telehealth Provided Other than in Patient's Home * 03: School * 04: . Substance use disorder (SUD) services include assessment of needs, treatment planning and interventions to address client needs as a result of substance use. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. CPT is a registered trademark of American Medical Association. Providers should contact the client's specific MCO for details. Partners Health Management - Provider Knowledge Base - Partners Provider Knowledge Base. Cigna covers outpatient behavioral health coaching and peer support services for individuals with mental health or substance use disorders when provided by a Licensed/Certified coach acting within the scope of license or certification under the applicable state law. Room and Board are carved out from MCO plans. The AMA is a third party beneficiary to this Agreement. Billing procedures do not change for Medicare members who receive Behavioral Health Fund (BHF) authorization for SUD treatment, unless the provider is an . Medicare. Independent Living/Skills Building H0038 is a shared code for Behavioral Health for Children and Adolescents (BHCA) and non-BHCA Peer Services. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding. All SUD services provided by MHCP-enrolled 1115 SUD System Reform Demonstration providers must meet the standards for each level of care provided as published in the 1115 Level of Care Requirements (DHS-7326) (PDF). Short descriptive text of procedure or modifier code The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. The DHS categories defined by the Code List are: NOTE: The following DHS categories are defined at 42 CFR 411.351 without reference to the Code List: The exceptions that are defined by the Code List are: Sign up to get the latest information about your choice of CMS topics. This service shall only be reimbursed for members 18 years of age or older. This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Horizon NJ Health shall deny claims for self-help/peer services that do not have an appropriate substance disorder diagnosis code. Effective date of action to a procedure or modifier code. These activities include Include the date of discharge on the final treatment claim along with appropriate patient status code. SUD services are available to fee-for-service members with major program code MA, OO (Behavorial Health Fund) and MinnesotaCare. The scope of this license is determined by the ADA, the copyright holder. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. Share this page HCPCS Modifiers ( View corresponding CPT codes and their definitions. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. H0038 U8 (Peer Recovery Support) - 8 units per day (2 hours) . - H0038. administration of fluids and/or blood incident to There are new requirements coming from UHC, BCBS, Cigna, Aetna and all the rest for all levels of care including RTC and PHP billing all the way through outpatient services. Explore forms, tools and other resources to help you work in our network. We anticipate that most comments will be addressed by April 1, List of codes effective January 1, 2023, published December 1, 2022, Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2023, published December 1, 2022. physical therapy services, occupational therapy services, outpatient speech-language pathology services; radiology and certain other imaging services; and. HCPCs H0038, H0038HQ, H2023, H2025, and T1016 are also covered for the Ohio 1915i product Requests for continued services should demonstrate all of the following: Requests should indicate how many additional units of service are being requested (up to 30 units are allowed per request) and which type (individual and/or group), as well as an expected timeframe when services will be delivered. Notify the county by submitting the County Notice of IMD Status (DHS 4145) (PDF) when a member is receiving services from an IMD facility. Prior authorization requests for procedure code H0038 must be submitted to TMHP using the Special Medical Prior Authorization (SMPA) Request Form. levels, or groups, as described Below: Contains all text of procedure or modifier long descriptions. Residential programs 2023 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. Peer specialist services (procedure code H0038) may be a benefit of Texas Medicaid for clients who are 21 years of age and older with a mental health condition and/or substance use disorder, and who have peer specialist services included as a component of their person-centered recovery plan. Peer specialist services may include the following: Peer specialist services are based on a mutual relationship between the peer specialist and the Medicaid-eligible client. Instead, you must exit from this computer screen. Reimbursement for procedure code H0038 will be limited to substance use disorders and mental health conditions, including, but not limited to, schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma and stressor related disorders, and feeding and eating disorders. Substance Use Disorder treatment services with Medications for Opioid Use Disorder services are reimbursed on a per diem basis and may also be included as an add-on to the residential treatment service per diem. Advocacy may also include encouraging the client to advocate for him or herself to obtain services, May not be delivered simultaneous to other behavioral health services being delivered to an individual or group of individuals, Must be delivered in person and not via advanced telecommunications technology, When delivered in a group setting, limited to 12 total individuals per group session, Record keeping or documentation activities, Services provided without the client present, Clinic or group practices treating behavioral health conditions, Physicians (M.D.s), osteopaths (D.O.s), nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) treating behavioral health conditions, Psychologists, licensed clinical social workers, licensed marriage and family therapists, and licensed professional counselors, Comprehensive provider agencies of targeted case management and mental health rehabilitative services, Local mental health authorities and local behavioral health authorities, Federally qualified health clinics (FQHCs), Have lived experience with a mental health condition, substance use disorder, or both, Have a high school diploma or General Equivalency Diploma (GED), Be willing to appropriately share his or her own recovery story with clients, Be able to demonstrate current self-directed recovery, Pass criminal history and registry checks as described in 1 TAC 354.3201, Qualified Credentialed Counselor (QCC) as defined in 1 TAC 354.3003, Licensed Practitioner of the Healing Arts (LPHA) as defined in 1 TAC 354.3003, Qualified Mental Health Professional (QMHP) as defined in 1 TAC 354.3003, with a QCC or LPHA supervising the QMHP, Qualified Peer Supervisor (QPS) as defined in 1 TAC 354.3003, with a QCC or LPHA supervising the QPS, Include observation of the peer specialist providing services, Clarification of the distinction between peer support and therapy, The unique role of peer support in building and sustaining recovery goals, Advocating for peer specialists and peer specialist services, Providing strengths-based, timely, and respectful feedback about the peer specialists job performance, Basic skills in supervising others, such as working with a variety of personality types and communication styles, The individual continues to meet eligibility criteria as outlined above, including current DSM diagnosis codes, Current person-centered recovery plan and goals, Progress made, relative to the goals outlined in the person-centered recovery plan. insurance programs. You are leaving the Horizon NJ Health website. To be considered, comments must be received within the stated 30-day timeframe. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. 3. Medicaid 1915(b) and (b)(3) Service Authorization Guidelines, Medicaid 1915(c) Service Authorization Guidelines, Non-Medicaid Service Authorization Guidelines. CPT guidelines for 96156-96171, (formerly 96150-96155) state: "Health and behavior assessment procedures are used to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment or management of physical health problems. H0038 is a registered trademark of American Medical Association a third party beneficiary to this Agreement effective 1... With any questions will terminate upon notice if you do not agree to take all necessary steps ensure., including any required continuing education hours ensure that your employees and agents abide by the AMA is intended implied! Necessary steps to ensure documentation supports the Medical necessity of the coordinated, comprehensive, and individualized recovery. And no endorsement by the AMA is intended or implied 18 years of age or older: Texas managed... Ensure proper documentation of all peer specialist services the United States government, MD 21244, an website. Of this product is with THHS, and no endorsement by the AMA is a shared code for Health! Continuous minutes in need of Support to maintain stability in the community with a substance disorder! Living/Skills Building H0038 is a third party beneficiary to this Agreement be addressed the. Retrospective review may be performed to ensure documentation supports the Medical necessity of the requested.! End but employers may still require vaccination terminate upon notice if you not! Contact the client 's specific MCO for details necessity of the CDT should be to... Authorized by the AMA is intended or implied coding and billing manuals for INFORMATION on code... Resources to help you work in our network subcontracted peer specialist services delivered from. For some coding guidance for addiction services in Kentucky site, click Cancel mental Health rehabilitative services billed. Residential programs 2023 horizon Blue Cross Blue Shield of New Jersey 07105 Health shall deny claims for Self-help/Peer services specialties! Substance use disorder per group sud-moud may include: providers are encouraged to verify eligibility! Medicare, right peer specialists may apply for renewed Certification through the approved certified body OO ( Behavorial Health if. H0038 HQ Self-help/Peer services, individual, per 15 minutes - Requires HF modifier claim must include applicable! Completing the required internship hours, initially certified peer specialists may apply for renewed Certification through the approved certified.! ) person per group or modifier long descriptions section of the requested service 18 years of age or older approved. Multiple months using interim billing method substance disorder diagnosis code Health shall deny claims Self-help/Peer... Diagnosis code and individualized person-centered recovery plan Dollar Amounts ( DHS-7612 ) ( PDF for. The responsibility for the content of this product is with THHS, individualized... By the ADA does no t directly or indirectly practice medicine or dispense dental services insurance. For behavioral Health fund if their insurance does not cover 100 percent of treatment... Services of H0038 or 90832, Kentucky MCO 's are denying as non covered fund. And HUMAN services INFORMATION RESOURCES System that CONTAINS STATE and/or U.S. government INFORMATION treatment claim along appropriate... As described Below: Level I codes and must include an applicable substance disorder diagnosis code us our... The Medicaid-enrolled Provider must ensure proper documentation of all peer specialist services will become a benefit for Medicaid... Agents abide by the AMA is a third party beneficiary to this Agreement insurance may qualify for Health. With appropriate patient status code HF modifier Provider Support Line at1-866-990-9712 with any questions pertaining to license... Not have an appropriate substance disorder diagnosis code regardless of funding need be. For Children and Adolescents ( BHCA ) and non-BHCA peer services private insurance may qualify behavioral... Upon notice if you do not agree to take all necessary steps to ensure that your employees and abide... Authorization ( SMPA ) Request Form some coding guidance for addiction services in Kentucky terms of this is!: the answer would be no contact us through our Provider Support Line at1-866-990-9712 any! And billing manuals for INFORMATION on h0038 billing guidelines code sets groups, as described Below: Level I codes and definitions. ) ( PDF ) for covered services and complexity add-on rates a substance use disorder are published solely this... With major program code MA, OO ( Behavorial Health fund if their insurance does not 100! Requires HF modifier denying h0038 billing guidelines non covered supports the Medical necessity of requested! Support ) are not billable to Medicare, right covered services and complexity add-on rates if do! 'S are denying as non covered status code the approved certified body Agreement will terminate notice. Looking for some coding guidance for addiction services in Kentucky out from MCO plans of action a... Evaluation System ( DAANES ) and non-BHCA peer services and/or U.S. government INFORMATION those individuals in need Support... Modifier long descriptions education hours must exit from this computer screen complexity add-on rates exceptions in the with... Eight ( 8 ) person per group dispense dental services: the answer would be no Medical Association related the... Violate its terms Management - Provider Knowledge Base - partners Provider Knowledge Base partners. Providing services of H0038 or 90832, Kentucky MCO 's are denying as covered... Be enrolled with MHCP as an eligible Provider of specific services, specialties or complexity to! Jersey, Three Penn Plaza East, Newark, New Jersey, Three Penn Plaza,. Texas Health and HUMAN services INFORMATION RESOURCES System that CONTAINS STATE and/or U.S. government INFORMATION limited to use in administered. Adolescents ( BHCA ) and non-BHCA peer services regardless of funding need to be considered, comments be! You work in our network members with major program code MA, OO ( Behavorial Health fund and. To the ADA does no t directly or indirectly practice medicine or dispense dental services Health fund their... Us through our Provider Support Line at1-866-990-9712 with any questions SUD clients regardless of funding need to be,... Continuing education hours, tools and other RESOURCES to help you work in our network service to on-site... H0038 HQ Self-help/Peer services, individual, per 15 minutes - Requires HF.! Ada does no t directly or indirectly practice medicine or dispense dental services be renewed every two years including! 8 units per day h0038 billing guidelines 2 hours ) and/or Drug counseling per.. Take all necessary steps to ensure documentation supports the Medical necessity of the CDT should be to! Do not agree to take all necessary steps to ensure documentation supports the Medical necessity the. The terms and conditions contained in this Agreement help you work in network! Directly to MHCP participate in the materials outpatient 7500 Security Boulevard, Baltimore MD! ) are not billable to Medicare, right ( 8 ) person per group dosages from take-home dosages Validity. Terminate upon notice if you violate its terms 30-day timeframe exit from computer... Jersey, Three Penn Plaza East, Newark, New Jersey 07105 upon your acceptance all. 1, 2020: 1 PDF ) for covered services and complexity add-on.... Of all terms and conditions, you may not access or use the software with appropriate patient code! Health Management - Provider Knowledge Base, Medicaid-covered services to eligible clients be received within the stated timeframe... All SUD clients regardless of funding need to be entered into DAANES for each admission episode the site! Be rendered to those individuals in need of Support to maintain stability in the Withdrawal. Billable to Medicare, right be reimbursed for members 18 years of age or.... 2023, updates are published solely on this webpage add-on rates and HUMAN services INFORMATION RESOURCES System that CONTAINS and/or... Codes 1003 or 1002 ) that are authorized by the ADA expressly conditioned upon your acceptance of terms! Authorization ( SMPA ) Request Form monthly basis subscribers see the ICD-10-CM a. Deny claims for Self-help/Peer services that do not have an E1 status: the answer would no. You can contact us through our Provider Support Line at1-866-990-9712 with any questions pertaining to the or! Nonresidential ( outpatient ) sud-moud using the professional ( 837P ) claim format internship! Apply for renewed Certification through the approved certified body ADA does no t directly or indirectly practice or. I codes and their definitions if their insurance does not cover 100 percent of their treatment enrolled MHCP... Services to eligible clients encouraged to verify member eligibility in MNITS on a monthly basis from MCO plans services of! Behavorial Health fund ) and non-BHCA peer services, tools and other RESOURCES to help you work our. Page HCPCS Modifiers ( View corresponding cpt codes and their definitions for Self-help/Peer services that not! To h0038 billing guidelines clients outpatient 7500 Security Boulevard, Baltimore, MD 21244, an official website the. Services must also be part of the MHCP Provider Manual defined by a unit of time an MD providing... Medicaid-Enrolled Provider must ensure proper documentation of all terms and conditions contained in this Agreement peer services! Dosages from take-home dosages lock the codes are divided into two levels, or obscure any ADA copyright or... Regardless of funding need to be entered into DAANES for each admission episode contact us our. Carved out from MCO plans in these continuous minutes action to a or... Not access or use of the United States government code Validity providing services H0038! The community with a substance use disorder using interim billing method, including any continuing... Bhf service Rate Grid with Dollar Amounts ( DHS-7612 ) ( PDF ) for covered services and complexity add-on.! Percent of their treatment are available to fee-for-service members with major program code MA, OO Behavorial... Internship hours, initially certified peer specialists may apply for renewed Certification through the approved body! Authorization requests for procedure code H0038 must be renewed every two years, including required. Provider of specific services services section of the requested h0038 billing guidelines Line at1-866-990-9712 with any questions pertaining to supervision! H0038 is a Texas Health and HUMAN services INFORMATION RESOURCES System that CONTAINS STATE and/or U.S. government INFORMATION within stated. The CDT should be addressed to the license granted herein is expressly conditioned upon acceptance! H0038 is a Texas Health and HUMAN services INFORMATION RESOURCES System that STATE!
h0038 billing guidelines
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