Behavioral Health Crisis Management Billing FAQs

This page answers the most frequently asked questions (FAQs) about how to bill for behavioral health (BH) services in acute and psychiatric hospitals.

General Billing Guidance

1. Can observational services be billed for on the same day as BH crisis management?
   • If the patient is receiving a medical observation, the provider can bill both observation codes and BH crisis management (S9485 with V1 or V2) on the same day. However, the observation cannot be billed as a replacement for BH crisis management (S9485 with V1 or V2). 
2. When does the BH crisis management service start? 
   • BH crisis management services (S9485 V1 or V2) should be billed on any calendar days after receiving the initial BH crisis evaluation.
3. How should hospitals bill for BH crisis management services with the modifiers V1 or V2 if a patient changes acuity levels within one calendar day?
   • If a hospital is providing BH crisis management services to a patient in accordance with standards defined in the RY24 Acute Hospital RFA, and that patient’s acuity changes from V1 to V2 levels or V2 to V1 levels within a calendar day, the hospital may bill with the higher acuity tier modifier V2 for that calendar day. If a patient receiving BH crisis management services has a different acuity level from one calendar day to the next, the hospital should bill the modifier that most fits that patient’s presentation for each respective calendar day.
4. Under what circumstances should hospitals bill for BH crisis management services S9485 with V1 or -V2)?
   • See the RY24 Acute Hospital RFA, Appendix K, Section III.B for further direction on when to bill S9485 with V1 and S9485 with V2.

Technical Billing Guidance

1. Will MassHealth reimburse professional fees, including for evaluation and management services, in addition to behavioral health crisis evaluation and behavioral health crisis management services?
   • Yes. The S9485 with V1 or V2 code encompasses all activities included in the BH crisis management service.  Hospitals are allowed to bill for other behavioral health interventions provided to the same member on the same day, as is the current practice.
   • Clinical services outside the scope of the BH crisis management service include, but are not limited to, direct psychiatric evaluation of the member by a psychiatrist or advanced practice provider (advanced practice registered nurses or physician assistants) requested by the primary hospital medical team for diagnostic clarification and treatment recommendations.
   • See the RY24 Acute Hospital RFA, Appendix K, Section II.C for procedural components of BH crisis management services. Procedural components are considered in scope of the respective services.
2. Will MassHealth issue payment for the Diagnostic Related Group (DRG) payment for admission in addition to BH crisis management tiered payment?
   • Yes. Hospitals providing BH crisis evaluation and/or management services can continue to bill any other clinical services.

Allowable Providers

1. Must S9485-V1 or -V2 be billed by individual service providers? 
   • No. S9485-V1 or -V2 must be billed through the hospital provider.
2. Are BH crisis management services (S9485 withV1 or -V2) billable in inpatient psychiatric settings? 
   • No. Hospitals providing inpatient behavioral health services should follow billing instructions specific to inpatient psychiatric claims.

Telehealth

1. May providers bill the S9485-V1 or -V2 code using a telehealth modifier if the evaluation is performed by clinicians who are not on-site and utilizing appropriate telehealth modalities? 
   1. Yes, S9485-V1 or -V2 codes may be billed using telehealth modifier. Reference MassHealth All Provider Bulletin 379 for more information. 

Insurer-Specific Guidance

1. Will the BH crisis management services be paid under Medical Benefit through MassHealth or MCO directly?
   • Follow plan-specific billing guidance.
2. Are all members with MassHealth secondary coverage eligible for S9485 with V1 or V2 or is this only for MassHealth Medicaid HMO plans when they are primary?
   • All members with Medicare primary and MassHealth secondary are covered for S9485 with V1 or V2 (BH crisis management).
3. Are dual Medicare-Medicaid members eligible for BH crisis management (S9485 with V1 or V2) services?
   • Yes, dual eligible plan members are eligible for BH crisis management (S9485 with V1 or V2) services. 
4. When a MassHealth member has Medicare primary and MassHealth secondary, should providers bill the S9485 V1 or V2 code to Medicare first?
   • When a member has Medicare primary and MassHealth secondary, the provider should bill S9485 V1 or V2 to MassHealth and receive the MassHealth allowed amount as reimbursement for claims submitted.
5. Are Medicare Advantage members who have MassHealth secondary coverage eligible for BH crisis management (S9485 with V1 or V2)?
   • Hospitals may follow the same billing instructions for MassHealth members with TPL whether they have traditional Medicare or Medicare Advantage as the primary insurer. If the patient has Medicare (traditional or Medicare Advantage), without MassHealth secondary, the hospital may bill MBHP for BH crisis evaluation services and bill HSN for BH crisis management services.
6. Are patients with HSN coverage eligible for BH crisis management (S9485 with V1 or V2) services?
   • Yes, patients with HSN coverage are eligible for BH crisis management (S9485 with V1 or V2) services. 

Recovery Support Navigator (RSN) Services

1. How is RSN defined? Who is allowed to supply the services, and which entity may bill for the services?
   • Refer to the RY24 Acute Hospital RFA Appendix N and 130 CMR 418: Substance Use Disorder Treatment Services for more detail on RSN services.  The RSN supplies the service, and the employing facility bills (in 15-minute units) through their employing facility.
2. Should hospitals bill for RSNs under a managed care plan’s medical benefit or behavioral health benefit?
   • Hospitals should consult the member’s managed care plan’s guidelines for whether behavioral health services are covered under the medical benefit or a separate behavioral health benefit.
3. If a patient is in the hospital awaiting outside facility placement, may a hospital bill for H2015-TF only once for the establishment of community support services or may the hospital bill multiple times if there is consistent comprehensive communication regarding community support services?
   • H2015-TF is billed in units, where one unit is 15 minutes of service. There is no prior authorization required for RSN services for the first 180 units per member (45 hours of service). RSN services complement discharge planning activities and coordination of care for MassHealth members with substance use disorder (SUD) and/or co-occurring disorders.
   • Hospitals should consult the member’s managed care plan guidelines for any requirements related to units of service that a member can receive, or notification or registration procedures for such services.

Other

1. Is there any hour or day limitation on Observation services (OBS) [e.g., 72 hours then must be flipped to inpatient Place of Service (POS)]?
   • Follow Centers for Medicare (CMS) & Medicaid Services National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) guidelines.
2. How do we bill for individuals with a supplemental plan and Medicare?
   • Contact the supplemental plan for billing guidance on those patients.
3. What is the MBHP uninsured group number?
   • The MBHP uninsured group number is 840003.
4. Some EDs are not contracted with the BH benefit—can they still bill through medical benefit?
   • Consult with each health plan for plan-specific billing guidance.
5. What is a warm handoff to a Community-Based Mobile Crisis Intervention (MCI) team on day of discharge from a hospital? Will MassHealth reimburse hospitals for days where warm handoff occurs?
   • Warm handoff to a Community-Based MCI team means the hospital team facilitates a smooth disposition into the community by contacting the regional Community BH Center’s MCI team and coordinating an appointment between the patient and the MCI team on the day of discharge.
   • On the day of discharge, MassHealth will reimburse a hospital for BH crisis management services provided in the hospital and reimburse a Community Behavioral Health Center (CBHC) for MCI services provided by the community-based team.
6. Will hospitals be required to complete the encounter form previously submitted by Emergency Service Programs?
   • No. At this time, Hospitals are only required to participate in the “Reporting and Community Collaboration Expectations” as outlined in the RY24 Acute Hospital RFA.
   • This includes:
     • notifying the Massachusetts Behavioral Health Access (MABHA) website no later than 24 hours after a MassHealth member identified as requiring inpatient psychiatric hospitalization arrives in the Acute Hospital’s ED and has not yet been admitted to an appropriate inpatient psychiatric setting, and
     • following the Expediated Psychiatric Inpatient Admission (EPIA) protocol for reporting all individuals awaiting psychiatric inpatient placement (EPIA protocol may be accessed here: Expedited Psychiatric Inpatient Admissions (EPIA) Policy.
7. If the patient was admitted to inpatient psychiatry unit or a medical-surgical unit, does the claim for BH crisis evaluation and/or management services roll into the inpatient bill?
   • If the member was admitted to the medical-surgical unit or an inpatient psychiatric unit through the E D, the hospital must submit S9485 on a professional claim (837P) with MassHealth Inpatient Provider ID and service location to MassHealth. S9485 will be reimbursed in addition to the inpatient covered charges. For BH crisis evaluation and management services rendered on the dates before the inpatient admission, follow the standard billing practice and submit an institutional (837I) claim with medical charges and BH crisis evaluation (S9485) to MassHealth.
8. Will any prior authorization process be required by MassHealth or Managed Care Entities (MCEs)?
   • No.
9. How can hospitals determine which claims fall into the MassHealth FFS scope and which claims are carved out to MBHP?
   • Hospitals should check the Eligibility Verification System (EVS) for eligibility and to determine the Member’s plan enrollment. If the Member is not enrolled in MBHP or any other managed care plan, the hospital may bill directly to MassHealth.

Date published:	April 30, 2024