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ERISA and self-funded plans not regulated by the DOI

Acute care billing instructions for behavioral health services provided for ERISA and self-funded plans not regulated by the Department of Insurance (DOI.)
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BH Crisis Evaluation (Required of Hospitals)

On initial day of readiness (S9485, no modifier)

ED-BasedMed/Surg
Plan coverage is plan specific.Plan coverage is plan specific.

BH Crisis Management

On days subsequent to the initial BH Crisis Evaluation for individuals experiencing a behavioral health crisis in need of ongoing behavioral health crisis supports (S9485-V1 or -V2)

ED-BasedMed/Surg
Plan coverage is plan specific.Plan coverage is plan specific.

MOUD Induction

For initiation of medication for opioid use disorder in the emergency department for MassHealth members who consent to initiation (G2213)

Ed- Based Only

Plan coverage is plan specific.

Recovery Support Navigator (RSN)

RSN services provided in the emergency department or medical/surgical floors (H2015-HF)

ED-Based

Med/Surg

Plan coverage is plan specific.

Plan coverage is plan specific.
Date published: April 30, 2024

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