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MBHP Behavioral health benefit for PCC Plan

Acute care billing instructions for behavioral health services rendered by MBHP Behavioral health benefit for PCC Plan, C3, and Steward network providers.
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BH Crisis Evaluation (Required of Hospitals)

On initial day of readiness (S9485, no modifier)

ED-Based

Med/Surg

S9485 can be billed on a HCFA 1500 or a UB04 but MBHP prefers providers use a HCFA 1500. There are no revenue code limitations however, the HCPCS Level II is needed on the claim.

When using a HCFA 1500 form, crisis evaluations should be billed with HCPCS S9485 with place of service code 23 (Emergency Department), 1 Unit = 1 day, maximum 1 unit per day.

Submit a professional claim (837P) with S9485 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.

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

S9485 can be billed on a HCFA 1500 or a UB04 but MBHP prefers providers use a HCFA 1500. There are no revenue code limitations however, the HCPCS Level II is needed on the claim.

When using a HCFA 1500 form, crisis evaluations should be billed with HCPCS S9485 with place of service code 23 (Emergency Department), 1 Unit = 1 day, maximum 1 unit per day.

Submit a professional claim (837P) with either S9485-V1 or -V2 as appropriate for any calendar day. Include 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

G2213 can be billed on a HCFA 1500 or a UB04 but MBHP prefers providers use a HCFA 1500. There are no revenue code limitations however, the HCPCS Level II is needed on the claim.

When using a HCFA 1500 form, crisis evaluations should be billed with HCPCS S9485 with place of service code 23 (Emergency Department), 1 Unit = 1 day, maximum 1 unit per day.

Recovery Support Navigator (RSN)

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

ED-Based

Med/Surg

H2015-TF can be billed on a HCFA 1500 or a UB04 but MBHP prefers providers use a HCFA 1500. There are no revenue code limitations however, the HCPCS Level II is needed on the claim.

When using a HCFA 1500 form, crisis evaluations should be billed with HCPCS S9485 on a HCFA 1500 form with place of service code 23 (Emergency Department), 1 Unit = 1 day, maximum 1 unit per day.

Submit a professional claim (837P) with code H2015-HF. Include 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.
Date published: April 30, 2024

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