Behavioral Health Coding: Converting Medicaid HCPCS to Medicare CPT

[ccosta]

Hello all,

I've been tasked to convert the current "H" & "T" HCPCS codes used by Medicaid for Behavioral Health services into Billable CPT codes for Medicare. Odd yes, however as a Medicare Advantage Organization that utilizes Risk Adjusted Codes (HCCs) [Diagnostic] for submission to CMS, and now with ACA plans utilizing Risk Adjusted Codes as well, the list used by Medicaid is NOT accepted by Medicare for submission.

I have crossed walked a good portion of them, yet they are some that I have yet to find a CPT code for, any help would be appreciated.

These are the tricky ones: In-depth assessment either new or established patient done by provider with a Bachelors or Master degree but not physician; Targeted Case Management for Children and Adults; Behavioral Services for a Day - Substance Abuse or Mental Health; Behavioral Health Medical Screening - Substance Abuse or Mental Health; Treatment Plan Development and Review - Substance Abuse or Mental Health; Bio-psychosocial Evaluation - Substance Abuse or Mental Health by provider with a Bachelors or Masters degree but not physician.

Any suggestions, help, or answers would be of great help. Project ends 3/18/2016.

Thank you,

Carl

 

[Robyn07]

Hi Carl,

You should be able to use the following:
In-depth assessment either new or established patient done by provider with a Bachelors or Master degree but not physician - 90791
Targeted Case Management for Children and Adults - Not billable
Behavioral Services for a Day - Substance Abuse or Mental Health - I am unaware of a behavioral health "Day" code that Medicare allows
Behavioral Health Medical Screening - Substance Abuse or Mental Health - 90792
Treatment Plan Development and Review - Substance Abuse or Mental Health - I am unsure of how to bill for this separately unless it is combined with some Psychotherapy
Bio-psychosocial Evaluation - Substance Abuse or Mental Health by provider with a Bachelors or Masters degree but not physician - 90791

The 90791 & 90792 are biopsychosocial assessments in and of their own and should be tailored to include the specifics such as substance use or abuse and other histories needed and/or areas reviewed.

I hope this helps.

Robyn
Robbiepooh63@gmail.com

 

[ccosta]

Thanks, I will incorporate these into my proposal.