WellSense/BMC for ACO and SCO Plans

Acute care billing for behavioral health services rendered by WellSense/BMC for Accountable Care Organizations (ACO) and Senior Care Option (SCO) network providers.

BH Crisis Evaluation (Required of Hospitals)

On initial day of readiness (S9485, no modifier)

ED-Based	Med/Surg
S9485 billed on the OP, one unit per day, no more than one per hospital stay. Submit on an OP institutional claim (837I).	S9485 billed on the OP, one unit per day, no more than one per hospital stay. Submit on a professional claim (837P).

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 V1 or V2 modifier, one unit per day. Submit on an OP institutional claim (837I).	S9485 V1 or V2 modifier, one unit per day. Submit on a professional claim (837P).

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, one unit per day. Submit on an OP institutional claim (837I).

Recovery Support Navigator (RSN)

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

ED-Based	Med/Surg
H2015-TF. Submit on an OP institutional claim (837I).	H2015-TF. Submit on a professional claim (837P).

Date published:	April 30, 2024