Therapeutic and Evaluative (T&E)

Mental Health Services

for Children

Provider Training

October 30, 2014

O f f i c e o f t h e G o v e r n o r | M i s s i s s i p p i D i v i s i o n o f M e d i c a i d

Policy/Administrative Code

• Current Policy Section 21 T&E Mental Health Services for Children has not been updated since 2009 aside from reformatting.

• Administrative Code Proposed Effective Date of July 1, 2015.

• Once the code has been approved a Late Breaking News article will be posted on the Xerox web site and also placed in the Provider Bulletin.

O F F I C E O F T H E G O V E R N O R | M I S S I S S I P P I D I V I S I O N O F M E D I C A I D 2

What Will Stay the Same

• Population – T&E services are for children under the age of 21.

• Covered Services – There will be no change in coverage for these services.

What Will Stay the Same

• Providers – Regardless of the type of T&E provider (individual provider or a group practice) currentlyo Licensed Professional Counselors (LPCs) cannot provide

T&E services.o Psychometrists are not allowed to conduct the testing for

evaluations or complete psychological evaluations. o Licensed Clinical Social Workers (LCSWs) cannot provide

services to adults.o Psychological Evaluations must be completed by a

licensed psychologist & should include any recommendations for placement or therapy services, etc.

What Will Change

• Name of the service is currently Bio-psycho-social Assessment will be changed to Psychiatric Diagnostic Evaluation.

• The corresponding HCPCS code (H0031) to CPT Code (90791).

• The rate will be updated to reflect the change from a HCPCS to a CPT code.

• Definitions will be expounded to include the clinical purpose.

What Will Change

• Documentation RequirementsoThe Date of service with the day, month, and year.oInstead of just the name, title, and signature; it will be necessary to include the credentials of the person who provided the service AND the person who documented the service, if two different people.oDocumentation should be legible so it can easily be read by reviewers.

Proper Billing Guidelines

• Place of Service (POS)• National Correct Coding Initiative (NCCI)• Group Therapy• Modifiers• Billing on One Claim Form

Place of Service (POS)

• Please use the appropriate POS on your claims.o 3- Schoolo11- Officeo12-Homeo14-Group Homeo99- Other

• Note: POS 53 is not an appropriate POS.

NCCI Edits

• The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B and Medicaid claims.

• Please note the Medicaid NCCI program is different than the Medicare NCCI program.

• NCCI Edit files are updated quarterly.• Medicaid NCCI Edit files and reference documents can be

found at this link: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html

NCCI Edits

• Procedure codes for mental health services fall under the Procedure To Procedure (PTP) edits for practitioner and ambulatory surgical center services.

NCCI Edit

• “How to Use the Medicare National Correct Coding Initiative (NCCI) Tools” at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCI-Tools.pdf provides useful information on pages 4 - 6 about the column 1/column 2 code pairs. Pages 13 -14 provide useful information on how to filter the edits.

Modifiers for NCCI Edits

• Modifier Indicator Table

Modifier Indicator Definition

0 (Not Allowed) There are no modifiers associated with NCCI that are allowed to be used with this code pair; there are no circumstances in which both procedures of the code pair should be paid for the same beneficiary on the same day by the same provider.

1 (Allowed) The modifiers associated with NCCI are allowed with this code pair when appropriate.

9 (Not Applicable) This indicator means that an NCCI edit does not apply to this code pair. The edit for this code pair was deleted retroactively.

NCCI Edit Modifier Indicator Example

NCCI and Group Therapy• Only one Group Therapy (90853) is allowed to be

billed per date of service according to the information available in Section V on page 40 at this link: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html.

Modifiers for T&E Services

• HA modifier should be placed on all T&E claims in the 1st modifier position.

• For an NCCI Edit the most appropriate modifier should be placed in the 2nd modifier position, which can be found on the NCCI Edit page. You may also find the most appropriate modifier by referencing the most current CPT Code Book.

Billing on One Claim

• Services provided to the same beneficiary on the same date of service should be billed on one claim form.

Contacts

• Kimberly Evans – Mental Health ServicesKimberly.Evans@medicaid.ms.gov

• Charlene Toten – Mental Health ServicesCharlene.Toten@medicaid.ms.gov

• Kimberly Sartin – Mental Health ServicesKimberly.Sartin@medicaid.ms.gov

• Bonlitha Windham – Office DirectorBonlitha.Windham@medicaid.ms.gov

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