Senior WholeHealth

Acute care billing instructions for behavioral health services rendered by Senior WholeHealth network providers.

BH Crisis Evaluation (Required of Hospitals)

On initial day of readiness (S9485, no modifier)

ED-Based	Med/Surg
Submit a single institutional (837I/UB-04) claim with BH crisis evaluation (S9485) with revenue code 0900. Providers may bill for no more than one unit per day, no more than once per acute hospital stay. S9485, without a modifier, cannot be billed on the same date of service as Behavioral Health Crisis Management Services (S9485, with modifier V1 or V2).	Submit a single institutional (837I/UB-04) claim with BH crisis evaluation (S9485) with revenue code 0900. Providers may bill for no more than one unit per day, no more than once per acute hospital stay. S9485, without a modifier, cannot be billed on the same date of service as Behavioral Health Crisis Management Services (S9485, with modifier V1 or V2).

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
Submit a single institutional (837I/UB-04) claim with BH crisis management (S9485 V1 or S9485 V2) with revenue code 0900. S9485, without a modifier, cannot be billed on the same date of service as Behavioral Health Crisis Management Services (S9485, with modifier V1 or V2).	Submit a single institutional (837I/UB-04) claim with BH crisis management (S9485 V1 or S9485 V2) with revenue code 0900. S9485, without a modifier, cannot be billed on the same date of service as Behavioral Health Crisis Management Services (S9485, with modifier V1 or V2).

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

Submit a single institutional (837I/UB-04) claim with MOUD Induction (G2213) with revenue code 0900. Bill no more than one unit per day of the following when the service is provided in the ED: The G2213 add-on code can be billed for initiating buprenorphine in the ED for individuals who have signs or symptoms of untreated opioid use disorder. G2213, no modifier, may be billed no more than one unit per day, per Member, regardless of setting.

Recovery Support Navigator (RSN)

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

ED-Based	Med/Surg
Submit a single institutional (837I/UB-04) claim with RSN (H2015-HF) with revenue code 0900.	Submit a single institutional (837I/UB-04) claim with RSN (H2015-HF) with revenue code 0900.

Date published:	April 30, 2024