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

Procedure Code

Modifier

Procedure Code

Modifier

Modifier

90839 CR 90839 GT CR
90840 CR 90840 GT CR
90846 CR 90846 GT CR
90847 CR 90847 GT CR
90849 CR 90849 GT CR
90853 CR 90853 GT CR
90785 CR 90785 GT CR
90791 CR 90791 GT CR
90832 CR 90832 GT CR
90833 CR 90833 GT CR
90834 CR 90834 GT CR
90837 CR 90837 GT CR
98966 CR 99231 GT CR
98967 CR 99232 GT CR
98968 CR 99233 GT CR
99231 CR 99238 GT CR
99232 CR 99239 GT CR
99233 CR H2022 GT CR
99238 CR H2033 GT CR
99239 CR H2011 GT CR
99441 CR H0038 GT CR
99442 CR H0038 EN GT CR
99443 CR H0038 DJ GT CR
H2022 CR H0038 HQ DJ GT CR
H2033 CR
H2011 CR
H0038 CR
H0038 EN CR
H0038 DJ CR
H0038 HQ DJ CR
H0040 CR
H0040 EN DJ CR
H0040 EN CR
H0040 DJ CR

 

MEDICAID ONLY Base Code

Modifier

Modifier 

H0040 GT CR
H0040 EN DJ GT CR
H0040 EN GT CR
H0040 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
97151 NC CR
97151 CR
97152 NC CR
97152 CR
97153 CR
97154 CR
97155 CR
97156 CR
97157 CR
97151 NC GT CR
97151 GT CR
97152 NC GT CR
97152 GT CR
97153 GT CR
97154 GT CR
97155 GT CR
97156 GT CR
97157 GT CR

STATE ONLY

Base Code Modifier
H2015 HT CR
H2015 HT GT

IN-LIEU OF MEDICAID CODES

Base Code Modifier
H0015 U5
H2017 U5

 

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:

INNOVATIONS

Base Code Modifier Modifier
H2015 CR XU
H2015 HQ CR XU
H2016 CR XU
H2016 U2 CR XU
H2016 HI CR XU
H2016 HI U2 CR XU
H2025 CR XU
H2025 HQ CR XU
H2025 TS CR XU
H2025 TS HQ CR XU
H2025 U2 CR XU
T2013 TF CR XU
T2013 TF HQ CR XU
T2014 CR XU
T2014 U2 CR XU
T2020 CR XU
T2020 U2 CR XU
T2021 CR XU
T2021 HQ CR XU
T2027 CR XU
T2033 CR XU
T2033 HI CR XU
T2033 TF CR XU
T2033 U1 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)