Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Chronic Disease and Rehabilitation Outpatient Hospital Bulletin 3 December 2007 TO: Chronic Disease and Rehabilitation Outpatient Hospitals Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: New Service Code to Claim and Report Behavioral Health (Mental Health and Substance Abuse) Screenings for MassHealth Members Under the Age of 21 Years Background This bulletin explains the limited use of Service Code 96110 (Developmental testing, limited, with Interpretation and report). This code is limited to billing MassHealth for services described below. In addition to this bulletin, MassHealth has issued Transmittal Letter ALL-155, dated December 2007, which also describes the limited use of Service Code 96110. New Behavioral Effective December 31, 2007, MassHealth is requiring all primary-care Health Screenings providers to offer to conduct behavioral-health screens at Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and Pediatric Preventive Health-care Screening and Diagnosis (PPHSD) visits for MassHealth members under the age of 21 using a standardized screening tool. This requirement includes primary-care providers who practice at chronic disease and rehabilitation outpatient hospitals. MassHealth is implementing this standardized behavioral-health screening requirement by amending MassHealth regulations at 130 CMR 450.140 through 450.150 and Appendix W (EPSDT Medical Protocol and Periodicity Schedule) of your MassHealth provider manuals. The menu of standardized screening tools appears in Appendix W. MassHealth pays for the administration and scoring of the standardized behavioral screening tool in accordance with Appendix W only for members under the age of 21. Billing Effective, December 31, 2007, Service Code 96110 can be used only to bill MassHealth for a standardized behavioral health screening for a MassHealth member under the age of 21. This code must be billed (continued on next page) Billing using the modifiers listed below. Starting on July 1, 2008, MassHealth will (cont.) deny any claim for Service Code 96110 that is submitted without a modifier. 961 96110+U1 The administration and scoring of a standardized behavioral-health screening tool selected from the approved menu of tools found in Appendix W of your provider manual for a MassHealth member (except MassHealth Limited), from birth to 21 years of age, with no behavioral-health need identified. 96110+U2 The administration and scoring of a standardized behavioral-health screening tool selected from the approved menu of tools found in Appendix W of your provider manual for a MassHealth member (except MassHealth Limited), from birth to 21 years of age, with behavioral-health need identified. Behavioral-health need identified includes needs in the areas of behavioral health, social-emotional well being, or mental health. If the primary-care provider administering the screening is hospital- salaried, the hospital must bill for the screening on the UB-04 claim form using an appropriate revenue code in addition to the service code and modifier above. If the primary-care provider administering the screening is not salaried by the hospital, the provider must bill according to the Physician Manual and refer to its Subchapter 6. MassHealth will not reimburse both the hospital and the primary care provider for administering the screening. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. MassHealth Chronic Disease and Rehabilitation Outpatient Hospital Bulletin 3 December 2007 Page 2