Issued: October 2, 2023
Effective Oct. 1, 2023, Partners Health Management began moving all new authorizations for Research-Based Behavioral Health Treatment (RB-BHT) to ALL codes. This applies to each RB-BHT service in order to condense the number of modifier codes needed for authorization. Authorizations with the new codes will be in ProAuth and Alpha by Oct. 14.
What is happening?
- RB-BHT services are transitioning to ALL codes.
- On Oct. 1, 2023, I/DD Utilization Management (I/DD UM) began creating new ALL code authorizations to extend authorizations that were end dated Sept. 30, 2023. These will be entered and visible in ProAuth and Alpha by Oct. 14, 2023.
- Current authorizations do not require updates.
Why is this happening?
Authorizations using ALL codes allows providers to bill for the appropriate service codes and modifiers without requiring individual service authorizations. This includes Telehealth and Non-Clinical modifier combinations.
What is changing for providers?
- Effective Oct. 1, providers will begin seeing authorizations for RB-BHT services reflecting the ALL codes.
- When submitting new RB-BHT requests, providers will enter the base code as the Primary Procedure Code on the Prescreen in ProAuth. (Base codes are reflected in the chart below.)
- On the Authorization Details screen, providers should select the Treatment Type that matches the selected Primary Procedure Code from the *Treatment Type drop down.
|Base Code||Treatment Type||Service Code/Modifiers covered by the ALL code Authorization|
|97151||97151 RB-BHT ALL||97151
97151 GT NC
|97152||97152 RB-BHT ALL||97152
97152 GT NC
|97153||97153 RB-BHT ALL||97153
|97154||97154 RB-BHT ALL||97154
|97155||97155 RB-BHT ALL||97155
|97156||97156 RB-BHT ALL||97156
|97157||97157 RB-BHT ALL||97157
How does this impact providers?
Providers should continue to submit claims using the specific service codes and modifiers.
Providers should continue to provide services in accordance with the member’s approved treatment plan as failure to do so may result in a recoupment. (Please be reminded that authorization is not a guarantee of payment.)
What if providers have questions?
Please contact UMQuestions@partnersbhm.org with any questions related to prior authorization.
Providers who want to learn more about RB-BHT services and updates may register for the next Autism Services Learning Collaborative using the link below. The collaborative will meet Wednesday, Oct. 11 from 1-2 p.m.
Registration Link: Autism Services Learning Collaborative (ASLC).