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telephone calls and after hour service

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Michele:
The description I find is "crisis intervention mental health services, per hour".  It doesn't indicate facility, but it also doesn't indicate if the service has to be face to face, or if it can be telephone.

Michele

Pay_My_Claims:
S9484 – Professional Treatment Services in Facility-Based Crisis Programs

11. Professional Treatment Services in Facility-Based Crisis Programs – Adults – S9484
This existing service serves as an alternative to hospitalization for adults (age 21 and older) who
have mental illness/developmental disability/substance abuse disorder. It is a 24 hour residential
facility that provides support and crisis services in a community setting. The services are provided
under the supervision of a physician with interventions implemented under the physician direction.
The purpose is to implement intensive treatment, behavioral management, interventions or
detoxification protocols to stabilize the immediate problems and to ensure the safety of the
individual. It is offered seven days/week and must be provided in a licensed facility. Medicaid
does not reimburse for room and board. Prior approval is required by the statewide vendor at the
end of eight hours if additional hours are needed.

This is a short-term service that does not exceed 15 days. This service cannot be billed for more
than a total of 30 days in a 12 month period.
This service is billed on an hourly basis and cannot exceed 16 units each day.

Michele:
Charlene,

       Is your description from a HCPCS book?  Just curious, because my research didn't show the facility description, but I wasn't looking in the HCPCS book.

Michele

Pay_My_Claims:
No, it isn't from the HCPCS coding book, it is the NC Medicaid billing guidelines for mental health billing.  but when i check other states its the same (for MEDICAID)

here is what SC states

Attention:  Enhanced Mental Health and Substance Abuse Service Providers
Professional Treatment Services in Facility Based Crisis Programs

Information published in Implementation Update #48 stated that Facility Based Crisis Programs could not be billed and reimbursed for adults under the age of 21 years old.  Through further advocacy with CMS, their decision was reversed, allowing Medicaid reimbursement for these services.  The implementation of this service expansion will occur as follows:

For Medicaid recipients age 18 through 20 years old, a new procedure code/modifier combination was implemented effective with date of service March 1, 2009.

    * Providers who are direct-enrolled can be reimbursed for services rendered by billing S9484 with modifier HA.
    * The rate of reimbursement for S9484 with modifier HA is $17.99 per unit (1 unit = 1 hour).
    * No more than 16 units can be billed and reimbursed per date of service.
    * No more than 480 units (30 days) can be billed and reimbursed within a calendar year.
    * All current policy applicable to S9484 with no modifier will apply to S9484 with modifier HA.

For Medicaid recipients age 21 years old and older, S9484 with no modifier should continue to be billed for reimbursement.

    * The rate of reimbursement for S9484 with no modifier will continue to be $17.99 per unit (1 unit = 1 hour).
    * No more than 16 units can be billed and reimbursed per date of service.
    * No more than 480 units (30 days) can be billed and reimbursed within a calendar year.
    * All current policy applicable to S9484 with no modifier remains in place.

The application of these separate procedure code/modifier combinations will allow DMA to assess the impact of the policy change.  The Service Definition Review Work Group convened by DMA and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services will be asked to develop the endorsement and service definition criteria for Facility Based Crisis Program services specific to Medicaid recipients under age 18.  Further information will be communicated as this process unfolds.

For any questions concerning this change in billing procedures, please contact EDS Provider Services at 1-800-688-6696 or 919-851-8888.

Behavioral Health Services
DMA, 919-855-4290

Michele:
OK, my info came from Value Options.  I wonder if it's just Medicaid specific.  Thanks for the clarification.

Michele

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