MedicaidJanuary 31, 2024
Mobile Crisis and Crisis Residence Authority and Reimbursement Changes: FAQ for providers
NYS received approval from the Centers for Medicare and Medicaid Services (CMS) for the Crisis Intervention State Plan Amendment (SPA) #22-0026. Effective March 1, 2024, the Crisis Intervention SPA consolidates and aligns Medicaid authority, coverage, and reimbursement policies for existing children and adults Mobile Crisis and Crisis Residence services. Medicaid Managed Care Plans are required to follow the guidance mobile crisis and crisis residential services.
1. How does this impact billing?
Answer:
Starting May 1, 2024, dates of service, all Mobile Crisis services will need to be billed as per the table below.
Category | Service | Rate Code | Procedure Code | Modifier | Authorization Required |
Mobile Crisis Adult & Children | Mobile Crisis Response - one person response, Licensed | 4615 | H2011 | HE | No |
Mobile Crisis Adult & Children | Mobile Crisis Response - two-person response - Licensed and Unlicensed/Certified Peer- up to 90 minutes | 4616 | H2011 | HK | No |
Mobile Crisis Adult & Children | Mobile Crisis Response - two-person response, both Licensed - up to 90 minutes | 4617 | H2011 | HE, HK | No |
Mobile Crisis Adult & Children | Mobile Crisis Response (90 - 180 minutes) Two-person Response: Licensed and unlicensed / Certified Peer | 4618 | S9484 | EP | No |
Mobile Crisis Adult & Children | Mobile Crisis Response (per diem) Two-person Response: Licensed and Unlicensed/Certified Peer -At minimum 3 hours of face-to-face contact | 4620 | S9485 | HE | No |
Mobile Crisis Adult & Children | Mobile Crisis Response Two-person Response: Both Licensed (90-180 Minutes) | 4619 | S9485 | HE, HK, U5 | No |
Mobile Crisis Adult & Children | Mobile Crisis Response (per diem) Two-person Response: Licensed -At minimum 3 hours of face-to-face contact | 4621 | S9485 | HE, HK | No |
Mobile Crisis Adult & Children | Mobile Crisis follow up - face to face - One person response, Licensed - up to 90 minutes | 4622 | H2011 | TS, HO | No |
Mobile Crisis Adult & Children | Mobile Crisis follow up - face to face - One person response, Unlicensed/Certified Peer - up to 90 minutes | 4623 | H2011 | TS, HM, HA | No |
Mobile Crisis Adult & Children | Mobile Crisis follow up - Two-person face-to-face Response: Licensed and Unlicensed/Certified Peer- up to 90 minutes | 4624 | H2011 | TS, SC | No |
Mobile Crisis Adult & Children | Telephonic Crisis follow up - Licensed -Up to 60 minutes (4 Units) | 4613 | H2011 | TS, GT | No |
Mobile Crisis Adult & Children | Telephonic Crisis follow up - Unlicensed/Certified Peer -Up to 60 minutes (4 Units) | 4614 | H2011 | TS, HM | No |
Mobile Crisis Adult & Children | Telephonic Crisis Triage and Response: Licensed Professional (up to 90 minutes) | 4609 | H2011 | GT |
|
Mobile Crisis Adult & Children | Telephonic Crisis Triage and Response: Unlicensed/Certified Peer (up to 90 min) | 4610 | H2011 | GT, HO | No |
Mobile Crisis Adult & Children | Telephonic Crisis Triage and Response: Licensed Professional (above 90 minutes) | 4611 | S9485 | GT | No |
Mobile Crisis Adult & Children | Telephonic Crisis Triage and Response: Unlicensed Professional (above 90 minutes) | 4612 | S9485 | HO | No |
Starting May 1, 2024, dates of services, all Crisis Residential Services need to be billed as per the table below
Category | Service | Rate Code | CPT | Modifiers | Authorization Required |
Crisis Residential Children & Adult | Residential Crisis Support | 4625 | T2034 | HE | Yes- Notification Required |
Crisis Residential Children & Adult | Intensive Crisis Residence | 4626 | T2034 | ET | Yes- Notification Required |
Crisis Residential Children & Adult | Children Crisis Residence (Up to age 21) | 4627 | T2034 | HK | Yes- Notification Required |
2. Can I still bill using rate codes that I used in 2023?
Answer: No, for Dates of Service May 1, 2024, the rate codes listed above will need to be used. Other rate codes 7906 – 7910; 7936 – 7942 and 7943 -7945 will be discontinued and the claim will deny if these discontinued rates codes are billed.
3. Who can bill for these services?
Answer: All currently designated Mobile Crisis and licensed Crisis Residence providers all existing providers with CFTSS and 1115 Waiver Mobile Crisis and Crisis Residence providers CPEPs.
4. Do I need to amend my contract?
Answer: No.
5. Who do I call if I want to contract with Anthem?
Answer: https://www.carelonbehavioralhealth.com/providers/join-our-network
6. Whom do I contact if I have additional questions?
Answer: Please contact Provider Services at 1-866-231-0847
7. Where can I find more resources?
Providers should bill services in accordance with NYS Medicaid guidelines.
Please use our provider website to find additional information and resources: Provider Website
Claims Submission (including out of network claims):
- Online https://www.availity.com/
- Electronic claims payer IDs: For professional claims: 00803. For institutional claims: 00303
- Submit paper claims to:
Anthem
P.O. Box 61010
Virginia Beach, VA 23466-1020
Timely filing is within 90 days from the date of service, or per the terms of the Provider Agreement.
Empire provides an online resource designed to significantly reduce the time your office spends verifying eligibility, claims status, and authorization status. Log in to our website and browse through the Tools section for more details. Claims overview | Anthem
For questions or more information, contact Provider Relations at 1-866-231-0847.
Medicaid services provided by Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
NYBCBS-CD-049672-24, NYBCBS-CD-052279-24
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