BH Crisis Evaluation (Required of Hospitals)
On initial day of readiness (S9485, no modifier)
|
ED-Based |
Med/Surg |
|
|---|---|---|
|
For MassHealth Limited, submit a single institutional (837I) claim to MassHealth with medical charges and BH crisis evaluation (S9485) to MassHealth. S9485 will be reimbursed in addition to the covered outpatient medical charges. There is no revenue code limitation for S9485. |
|
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 |
|---|---|
|
For MassHealth Limited, submit a single institutional (837I) claim to MassHealth with medical charges and BH crisis evaluation (S9485) to MassHealth. S9485 will be reimbursed in addition to the covered outpatient medical charges. There is no revenue code limitation for S9485. |
For MassHealth Limited, submit a professional claim (837P) that includes MassHealth INPT (provider type 70) provider ID and Service Location, in addition to institutional (837I) claim with ED and INPT charges. Exclude from any facility/institutional claim (including Claim Types I and A) that the Hospital submits for the member’s stay. |
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 |
|---|
|
Not covered
|
Recovery Support Navigator (RSN)
RSN services provided in the emergency department or medical/surgical floors (H2015-HF)
|
ED-Based |
Med/Surg |
|---|---|
|
Not covered |
Not covered |
| Date published: | April 30, 2024 |
|---|