BH Crisis Evaluation (Required of Hospitals)
On initial day of readiness (S9485, no modifier)
|
ED-Based |
Med/Surg |
|---|---|
| When a BH provider renders a crisis evaluation in the ED, bill MGBHP on a UB-04 with S9485 (with applicable modifiers) and revenue code 900. |
When a BH provider renders in any location at the medical hospital (not in the ED) AND where Optum BH has a facility agreement (with the S9485 as part of their Facility Agreement), then bill Optumin accordance with the Agreement (Generally 900 + S9485) on the UB-04. Where Optum has a group agreement, bill S9485 to Optum on a professional claim form (HCFA-1500). If Optum does not have a facility or group agreement, the facility must contact Optum for a Single Case Agreement. |
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-Based |
Med/Surg |
|---|---|
|
When a BH provider renders crisis management in the ED, bill MGBHP on a UB-04 with S9485 with a V1 or V2 and revenue code 0900. |
When a BH provider renders in any location at the medical hospital (not in the ED), bill S9485 with a V1 or V2 modifier to Optum o AND where Optum BH has a Facility Agreement (with the S9485 as part of their Facility Agreement), then bill Optum in accordance with the agreement (Generally 900 + S9485 + V1 or V2) on the UB-04. Where Optum has a group agreement, bill S9485 and appropriate modifiers to Optum on a professional claim (HCFA-1500). If Optum does not have a Facility or Group Agreement, the facility must contact Optum for a Single Case Agreement. |
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 |
|---|
|
When the ED provider is billing independent of the facility, bill G2213 on a professional claim. When the ED provider is an employee of the Medical Hospital, bill G2213 on a facility claim using revenue code 0900. |
Recovery Support Navigator (RSN)
RSN services provided in the emergency department or medical/surgical floors (H2015-HF)
|
ED-Based |
Med/Surg |
|---|---|
|
When the BH provider renders RSN services in any location in the medical hospital, bill H2015-HF to Optum on a professional claim. When the Medical Hospital bills for RSN on a facility claim, bill H2015-HF to MGBHP using revenue code 0900. |
When the BH provider renders RSN services in any location in the medical hospital, bill H2015-HF to Optum on a professional claim. When the Medical Hospital bills for RSN on a facility claim, bill H2015-HF to MGBHP using revenue code 0900. |
| Date published: | April 30, 2024 |
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