BH Crisis Evaluation (Required of Hospitals)
On initial day of readiness (S9485, no modifier)
Billing Instructions are the same for both Ed-Based and Med/Surg and are as follows:
- BH Crisis Evaluations should be rendered in accordance with the Standards for BH Evaluations in the RY24 Acute Hospital RFA (Appendix I). The claim shall be submitted to Fallon Health and must be billed on the 837I (UB-04).
- This may be billed no more than one unit per day, no more than once per acute hospital stay. The hospital is the billing entity, not the individual provider.
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)
Billing Instructions are the same for both Ed-Based and Med/Surg and are as follows:
- BH Crisis Management should be rendered in accordance with the Standards for BH Crisis Management in the RY24 Acute Hospital RFA (Appendix K). The claim shall be submitted to Fallon Health and must be billed on the 837I (UB-04).
- This may be billed no more than one unit per day. It cannot be billed on the same day as a Behavioral Health Crisis Evaluation. S9485 with V1 cannot be billed on the same day as S9485 with V2. Behavioral Health Crisis The hospital is the billing entity, not the individual provider.
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 |
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MOUD should be rendered in accordance with the Standards for Initiation of Medication for the Treatment of Opioid Use Disorder in the RY24 Acute Hospital RFA (Appendix M). The claim shall be submitted to Fallon Health and must be billed on the 837I (UB-04). G2213 is an add-on code to be billed with evaluation and management visit codes used in the ED setting (99281-99285). MOUD (G2213) is not separately reimbursed when delivered in the medical/surgical setting. The hospital is the billing entity, not the individual provider.
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Recovery Support Navigator (RSN)
RSN services provided in the emergency department or medical/surgical floors (H2015-HF)
Billing Instructions are the same for both Ed-Based and Med/Surg and are as follows:
- RSN should be rendered in accordance with the Standards for Recovery Support Navigators in the RY24 Acute Hospital RFA (Appendix N). The claim shall be submitted to Fallon Health and must be billed on the 837I (UB-04).
- RSN services must be billed with the procedure code and modifier. The hospital is the billing entity, not the individual provider
| Date published: | April 30, 2024 |
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