Issued: April 24, 2020
Behavioral Health Service Flexibilities
On Thursday April 16, 2020, the Division of Health Benefits (NC Medicaid) issued Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities. This special bulletin builds upon flexibilities and guidance that Partners has previously shared. Your voices have been heard in the State workgroups, and Partners will continue our strong advocacy and commitment to the stability of the provider network.
As such, Special Bulletin #46 serves as a replacement and clarification to some previously posted flexibilities and guidance to questions that have been received regarding codes and modifiers.
GUIDANCE FOR GT/CR Modifiers: The following GT and/or CR modifiers have been added to provider contracts effective March 10, 2020. These codes were added to Medicaid and State contracts for existing providers of these outpatient and enhanced service codes as outlined below.
MEDICAID AND STATE COVID-19 MODIFIED CODES
|H2022||CR||H0038 HQ DJ||GT||CR|
|H0038 HQ DJ||CR|
|H0040 EN DJ||CR|
MEDICAID ONLY Base Code
|H0040 EN DJ||GT||CR|
|H2015 HT HN DJ||CR|
|H2015 HT HM DJ||CR|
|H2015 HT HO DJ||CR|
|H2015 HT HF DJ||CR|
|H2015 HT U1 DJ||CR|
|H2015 HT HO||GT||CR|
|H2015 HT HF||GT||CR|
|H2015 HT HN||GT||CR|
|H2015 HT U1||GT||CR|
|H2015 HT HM||GT||CR|
|H2015 HT HO||CR|
|H2015 HT HF||CR|
|H2015 HT HN||CR|
|H2015 HT U1||CR|
|H2015 HT HM||CR|
IN-LIEU OF MEDICAID CODES
In an effort to offer flexibilities to our Providers and assure members continue to receive services, Partners has written and received approval for two In Lieu of (ILO) Services. Although Medicaid has released the above Special Bulletin, specific to enhanced codes, Partners will continue to offer the ILO’s above to ensure providers have the option to provide the service that best meets the needs of the individuals they are serving.
Important to Note:
- Providers that have delivered these services via audio/visual since March 10, 2020 due to COVID-19 must add both modifiers (GT and CR) to the code when submitting for reimbursement.
- If the services were delivered telephonic only, then the provider will only use the CR code.
Providers that have already submitted claims and are receiving denials for incorrect use of modifiers will need to submit replacement claims for all claims previously submitted that require a different code on the claim. Partners will re-adjudicate all claims previously submitted with GTCR or CR once the rates are loaded.
The following Innovations codes have been added to provider contracts with an effective date of March 13, 2020 with no action required by the provider:
|H2016 HI U2||CR||XU|
|H2025 TS HQ||CR||XU|
|T2013 TF HQ||CR||XU|
Place of Service
Telemedicine and telepsychiatry claims related to COVID-19 shall be filed with the provider’s usual place of service for fee-for-service claims submitted to NCTracks. Claims submissions to LME-MCOs will follow the guidance of the LME-MCO.” (https://medicaid.ncdhhs.gov/blog/2020/04/16/special-bulletin-covid-19-46-behavioral-health-service-flexibilities).
Partners will mirror NC DHHS’s guidelines for Place of Service. Telemedicine and telepsychiatry claims related to COVID-19 shall be filed with the provider’s usual place of service for fee-for-service claims.(Special Bulletin COVID_19 #35)