ODM BH rate increases and policy updates
August 1 Rate Increases
The following services will have rate increases for dates of service on and after August 1, 2019. Please refer to the BH Provider Manual for the new rates. MITS will be updated August 2nd to incorporate these changes. Please wait until August 3rd to submit claims for August services.
- Crisis services for both mental health (MH) and substance use disorder (SUD) treatment – this includes 90839-90840 as well as those codes with a KX modifier. Please note nursing crisis codes do not have any rate increases (T1002 KX and H2019 KX services rendered by Registered Nurses-RNs)
- Group Psychotherapy and Group Therapeutic Behavioral Services (TBS) for MH and Group Counseling for SUD.
- Evaluation and Management Services and Diagnostic Psychiatric Evaluations provided by Clinical Nurse Specialists, Certified Nurse Practitioners, and Physician Assistants will be paid at 100% of the Medicaid maximum rate.
Note: Please keep in mind that Medicaid pays the lesser of the Medicaid rate or the billed amount. Any claim submitted on or after August 1st with a billed amount lower than the Medicaid rate will be considered a clean claim and will be appropriately reimbursed at the lower billed rate.