Behavioral Health H-Codes Per Diem Double Billing guideline change

Effective September 1, 2023, Anthem Blue Cross and Blue Shield Medicaid will no longer cover treatments for the same or similar diagnosis that are included in intensive-outpatient, partial hospitalization, and residential substance use disorder services per diem payments in accordance with Kentucky’s administrative regulations. Claims on or after September 1, 2023, for services included with per diems submitted on same date of service as a per diem treatment will be denied.

The codes are H0015 (intensive outpatient), H0035 (partial hospitalization), H0011, H2034, and H2036 (residential SUD).

Intensive-outpatient treatment shall include:

• Individual outpatient therapy, group outpatient therapy, or family outpatient therapy unless contraindicated.
• Crisis intervention.
• Psychoeducation related to identified goals in the recipient's treatment plan.

Partial hospitalization treatment shall include:

• Individual outpatient therapy, group outpatient therapy, family outpatient therapy.
• Medication management.

Residential substance use disorder treatment shall include:

• A screening.
• An assessment.
• Service planning.
• A psychiatric service.
• Individual outpatient therapy.
• Group outpatient therapy.
• Family outpatient therapy.
• Peer support services.

If you have questions about this communication, please contact your provider relationship management representative or the Provider Services department at 855-661-2028.