Correct billing of mobile crisis services

Anthem embraces opportunities to foster collaboration efforts with providers to help ensure proper coding and payment of claims. To this end, we would like to take a moment to review billing and coding practice around mobile crisis services to avoid any confusion that might arise with this new service.

Per IHCP Bulletin BT202364, mobile crisis services will be reimbursed when rendered by an Individualized Health Care Plan (IHCP) enrolled provider with a Division of Mental Health and Addiction (DMHA)-designation as a mobile crisis unit. If the provider is a community mental health center (provider type 11, specialty 111), reimbursement begins on the date they received mobile crisis designation by DMHA. However, it should be noted that IHCP Bulletin BT202430 updates this requirement such that to bill for mobile crisis services providers must be enrolled as Provider type 11 — Behavioral Health Provider, Provider specialty 622 — Mobile Crisis Unit. Community mental health centers must add the 622-specialty code as of June 1, 2024, to avoid disruption of payment for mobile crisis services.

IHCP Bulletin BT202430 also outlines further requirements for mobile crisis providers not part of community mental health centers. In addition to the group provider classification (provider type 11), they will need to enroll with at least one of the following associated rendering providers:

• Type 09 — Advanced Practice Registered Nurse
• Type 11 – Behavioral Health Provider:
  • Specialty 618 — Licensed Clinical Social Worker (LCSW)
  • Specialty 619 — Licensed Marriage and Family Therapist (LMFT)
  • Specialty 620 — Licensed Mental Health Counselor (LMHC)
  • Specialty 621 — Licensed Clinical Addiction Counselor (LCAC)
• Type 31 — Physician

Provider specialty 622 — Mobile Crisis Unit can be a stand-alone specialty or added to an existing provider type 11 enrollment. However, stand-alone mobile crisis units can only be reimbursed for the services identified in IHCP Bulletin BT2023173 and billed with the following mobile crisis codes (per IHCP Bulletin BT202364):

Reimbursable crisis intervention services for DMHA-designated mobile crisis units, effective for dates of service on or after July 1, 2023:

Billing code	Code description	Service details
S9484	Mobile crisis response without transportation, up to 3 hours	Covers triage/screening, assessment, brief counseling, safety planning, peer recovery support, and follow-up stabilization services.
S9484 UB	Mobile crisis response with transportation, up to 3 hours	Covers triage/screening, assessment, brief counseling, safety planning, peer recovery support, and follow-up stabilization services.
S9485	Mobile crisis response without transportation, 3 hours or more	Covers triage/screening, assessment, de-escalation through brief counseling, safety planning, peer recovery support, and follow-up stabilization services.
S9485 UB	Mobile crisis response with transportation, 3 hours or more	Covers triage/screening, assessment, de-escalation through brief counseling, safety planning, peer recovery support, and follow-up stabilization services.
H0034 U9	Medication training and support, per 15 minutes	Covers monitoring medication compliance, providing education and training about medications, monitoring medication side effects, and providing other nursing/medical assessments, and allows for monitoring of medication-assisted treatment (MAT) and/or psychotropic medication services.
H2011 UA	Crisis intervention service, per 15 minutes	Covers a follow-up crisis assessment, crisis planning and counseling specific to the crisis.

Additionally, POS code 15 (mobile crisis) is to be used by designated providers when submitting claims for the initial mobile crisis response. For follow-up, providers should use the place of service code appropriate to where the visit takes place.

Regarding limitations for mobile crisis services, IHCP Bulletin BT2023173 states that no more than 23 hours are allowed per crisis episode. Follow-up services are limited to a daily maximum of 90 minutes for up to 90 days after the initial mobile crisis services.

IHCP Bulletin BT2023173 discusses retroactive payment for mobile crisis services. Though coverage of these services from July 1, 2023, onward, Medicaid reimbursement is not available for services rendered prior to the billing mobile crisis unit receiving its DMHA designation. Managed care contracted providers have a 90-day filing period for timely filing a claim submission.