Issued: April 30, 2020
Additional Service Flexibilities
The following codes have been added to Medicaid contracts with an effective date of March 10, 2020, with no action required by providers. These codes are in addition to those that were included in Partners Provider Alert COVID 19 #21-Behavioral Health Service Flexibilities | Place of Service, dated April 24, 2020.
As a reminder, providers should adhere to Medicaid guidance when using modified codes as follows:
- Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.
- Modifier CR (catastrophe/disaster-related) must be appended to all claims for CPT and HCPCS codes billed using the allowed flexibilities.
Partners has not automatically added to contracts any service codes with ONLY the GT modifier without also including the CR modifier. Providers who are in full compliance with all telehealth requirements with no COVID 19 flexibilities must request to have GT codes added using the Provider Change Form.
The three codes below have been end dated in provider contracts effective March 20, 2020. Although it was Partners’ intention to provide additional flexibilities using these codes, they were unable to be reimbursed at the level of service provided. Providers now have the option of using Partners In Lieu Of services or the flexibilities offered in the codes listed above. Providers should direct questions regarding these codes to your Provider Account Specialist or email the Provider Help Desk.
- H0015 CV – Substance Abuse Intensive Outpatient 15 minutes
- H0035 CV – Mental Health Partial Hospitalization 15 minutes
- H2022 CV – Intensive In-Home 15 minutes
Please note that claims previously approved will be re-adjudicated to recoup. Partners Claims Department will complete this process and will contact the provider once competed. Once recouped, providers should submit claims with the new procedure code. Please direct any claims-related questions to ClaimsDepartment@partnersbhm.org.
Outpatient Opioid Treatment (OOT) Service Authorization Requests
For Medicaid Members:
Effective June 1, 2020, Outpatient Opioid Treatment (OOT) providers may begin submitting Service Authorization Requests (SARs) for Medicaid members with the following service code:
H0020 (U3) (OU) – Weekly Rate for Outpatient Opioid Treatment
H0020U3OU is an alternative payment method utilized for Medicaid OOT. The cost of dosing visits, medication, medication dispensing and counseling will be bundled under a weekly rate. Please submit a Change Request Form to Credentialing and Enrollment if you are an Outpatient Opioid Treatment provider interested in adding this service to your contract.
The H0020 service code (no modifier) may be used for dually insured members with Medicare and Medicaid. Providers must submit claims to Medicare as primary payor before Medicaid.
OOT Retroactive SARs:
Partners Utilization Management will allow submission of OOT retroactive SARS for Medicaid members back to March 8, 2020. Retro dates may be requested from March 8, 2020 to March 18, 2020. No prior approval is needed during COVID-19 crisis effective March 19, 2020 through May 31, 2020. Providers may submit claims directly to Partners for services rendered during the COVID-19 crisis period. All retroactive SARS must be submitted to Partners Utilization Management by July 1, 20200.
Partners Outpatient Opioid Treatment Benefit Plan for Medicaid Members
|Service Description||Benefit Limit||Level of Care||Source||Documentation Required for Authorization|
|Outpatient Opioid Treatment:
H0020 – Per Diem
H0020 (U3) (OU) – Weekly
|Initial: 60 days
H0020 – 60 units for 60 days
H0020U3OU – 9 units for 60 days
Concurrent: 180 days
H0020 – 180 units for 180 days
H0020U3OU – 26 units for 180 days
|8A||Initial: Tx Plan. Service order is required and is due on or before the first date of service. Service Order must be signed by a MD or DO. Service Order is valid for one year.
Concurrent: Updated Tx Plan and signature page w/each request.
For State-funded Members:
Providers may continue to bill H0020U3OU for State-funded members. However, no prior approval or service authorization request is required at this time for State-funded H0020U3OU. Please consult the State-Funded Alternative Service Definition for Opioid Treatment Program Bundle for benefit limits and documentation requirements.
Prior approval is required for Office Based Opioid Treatment (OBOT) which are service codes YA396 (S1), (S2), and (S3).
OOT providers should note that the service code H0020U3BU has been discontinued for Medicaid and State-funded members.
If you have additional questions regarding service authorization requests, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.
If you have additional questions regarding Credentialing and Enrollment, please contact 704-842-6483.
Partners to Host Service Informational Sessions for Members and Their Families
Do you work with members that are confused about service changes due to COVID-19? Partners is here to help. Members that receive services from Partners’ providers as well as their family members are invited to an upcoming question and answer session:
Partners Member Information Session for Intellectual/Developmental Disabilities and Traumatic Brain Injury Service Changes
Tuesday, May 5, 2020 at 4 p.m.
Click here to register for the May 5 webinar
Partners Member Information Session for Mental Health and Substance Use Service Changes
Thursday, May 7, 2020 at Noon
Click here to register for the May 7 webinar
Members and their families are welcome to email any questions to firstname.lastname@example.org or call 704-884-2666 for more information.
Personal Protective Equipment
During the COVID-19 pandemic, there has been a shortage of Personal Protective Equipment (PPE). NC DHHS and the NC Department of Public Safety are actively working to get PPE to organizations in need. To learn more about conservation measures of existing supplies or to request additional PPE, please visit https://www.ncdhhs.gov/divisions/public-health/covid19/health-care-providers-hospitals-and-laboratories/requesting-ppe.
Joint Communication Bulletins
NC DHHS has published two Joint Communication Bulletins:
- Joint Communication Bulletin #361: Tool for Measurement of ACT (TMACT) and Individual Placement and Support (IPS) Fidelity Evaluations During the COVID-19 Response
- Joint Communication Bulletin #J362: NC Innovations Waiver Amendment: Budget Limit for Beneficiaries Receiving Supported Living Level III
Click here to view all Joint Communication Bulletins.