[PC-BH-Integration] Medicaid billing codes

[Sarah Bannon]

Hello:
 
You're questions are critical and I echo the comments made by Rodger that the state Medicaid program has everything to do with what codes (and if) these various behavioral health services will be recognized (read that as "payable") in a primary care setting.  I had the opportunity to spend four years doing technical assistance and training for HRSA with health centers that are integrating behavioral health services (still do this now but not so much through HRSA) and the diversity and solutions--or lack of opportunities--are very broad. Here are a few responses below that are more specific.  
 
1) what Medicaid codes are best used by the therapist for seeing children in primary care settings before a diagnosis is made? (if one is ever made) The 908- - series CPT codes (specialty outpatient behaivoral health) are still the most used across the country in a primary care setting--at least based on the 20 states I've work in. The Health and Behavior Assessment (HBA) codes, CPT series 96150-55 still hasn't gained the traction yet across the country--Medicare is the only consistent payor that accepts these codes so far but that has been "interesting" in some sites too.
2) what Medicaid code best addresses the consultation between a pediatrician/ primary care doctor and the child psychiatrist? (assuming the latter has not seen the patient in question) This hasn't been a recognized billable service anywhere I've worked.
3) have there been any issues for the pediatrician/ primary care doctor getting reimbursed for psychiatric codes? yes
4) have there been any issues with same day billing for both mental and medical disorders? The only state I've worked in that has had third party payors (not Medicaid-just commercial) allow same day double billing has been Maine.  So much of the state is rural that it seems as if the payors understand that if the MH services aren't provided in the pri care setting that they likely won't happen at all.
 
Best wishes as you proceed--SarahSarah B. Bannon, MSW, LMSW, ACSW Lakeview Consultants, LLC 12951 Chartreuse Dr. DeWitt, MI 48820 Phone: (517)669-5532 Mobile: (517) 927-3916 Fax: (517)669-5532This email and its attachments, if any, is intended only for the person(s)to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you have received this email in error, please contact the sender and delete the material from any computer.


From: Rodger.Kessler at vtmednet.orgTo: pc-bh-integration at lists101.his.com; pc-bh-integration at nccbh.netDate: Thu, 21 Feb 2008 13:55:28 -0500Subject: Re: [PC-BH-Integration] Medicaid billing codes




These issues are very(unfortunately) complex, and with medicaid vary by state. If it were me, my first action would be with the clic manager, discuss these questions with the State Meidcaid Director, to investigate A/ where they are, and B/ if where they are needs modification, how open they might be to a collaboration or pilot program. Hope this is useful. Rodger
 

Rodger Kessler Ph.D. ABPPClinical Assistant ProfessorDepartment of Family MedicineUniversity of Vermont College of MedicineBerlin Family HealthFletcher Allen Healthcare
-----Original Message-----From: pc-bh-integration-bounces at lists101.his.com [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Becker, Emilie ASent: Tuesday, February 19, 2008 1:00 PMTo: pc-bh-integration at nccbh.netSubject: [PC-BH-Integration] Medicaid billing codes
 
I am trying to initiate an integrated program in Texas for Medicaid children, and want to know 
1) what Medicaid codes are best used by the therapist for seeing children in primary care settings before a diagnosis is made? (if one is ever made)
2) what Medicaid code best addresses the consultation between a pediatrician/ primary care doctor and the child psychiatrist? (assuming the latter has not seen the patient in question)
3) have there been any issues for the pediatrician/ primary care doctor getting reimbursed for psychiatric codes?
4) have there been any issues with same day billing for both mental and medical disorders? 
 
Thanks very much.  EAB
 
Emilie A. Becker, M.D. 
DSHS
909 W. 45th, mail code 2018
Austin, Texas 78751 
512-206-5936
fax 512-206-5782
 
 
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