Important policy change — Medicare coverage for select services effective January 1, 2024

We are writing to remind you of a critical change to Medicare policy affecting the processing of certain behavioral health services. According to a notification from the Department of Medical Assistance Services (DMAS), Medicare began covering the following services starting May 1, 2024:

• Intensive Outpatient Services (Code: H0015 or REV 0906 with H0015)
• Marriage and Family Therapists (MFT’s)
• Mental Health Counselors (MHC’s)

Managed Care Organizations (MCOs) are mandated to deny claims for these services if an Explanation of Benefits (EOB) is not received from Medicare, as Medicaid will no longer be the primary carrier for these specific services. We began enforcing this policy on May 4, 2024.

For further details on this policy change, please refer to the following links:

• Medicaid alert: DMAS Official Notification
• CMS alert: Centers for Medicare & Medicaid Services Update

We advise you to review these changes and adjust your billing procedures accordingly. We appreciate your attention to this update and are committed to assisting you during this transition.

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.