Issued: March 15, 2022
NC Medicaid on March 2, 2022 released SPECIAL BULLETIN COVID-19 #234: UPDATE to Permanent Changes Made for PHE Flexibilities and Plan for Sunsetting of Temporary Policies
This Bulletin identifies all temporary Behavioral Health policy flexibilities outlined in COVID-19 Special Bulletin that will be end-dated as of March 31, 2022. The service listed below has not been made permanent into NC Medicaid Clinical Coverage Policy. Partners Utilization Management (UM) will allow a transition period for retroactive Service Authorization Request (SAR) submission through April 30, 2022. Providers will need a SAR that is effective April 1, 2022, for continuation of the service that is sunsetting on March 31, 2022.
Please see link for more details.
Below table identifies the Behavioral Health Service that is ending by March 31, 2022.
|Service||Changes effective March 31, 2022|
|SAIOP (Substance Abuse Intensive Outpatient)||A medical necessity review will be required after initial 30-day pass through:
H0015 GT CR
H0015 AD GT CR
For existing members receiving SAIOP without an authorization in Alpha, provider will need to submit a Service Authorization Request for medical necessity review on or before April 30, 2022.
The following services below identify changes in staffing and/or program delivery that will be sunsetting on March 31, 2022. For more details, please refer to bulletin:
- Mobile Crisis Management (MCM H2011, H2011 CR, H2011 GT CR)
- Multisystemic Therapy (MST H2033 M4-M5; H2033 M4-M5 GT CR)
- Intensive In-Home (IIH H2022, H2022 CR, H2022 GT CR)
- Outpatient Opioid Treatment (OOT H0020, H0020 U3 OU, H0020 U3 OU OT, H0020 OT, H0020 U3 OU CR, H0020 GT CR, H0020 CR)
- Child and Adolescent Day Treatment (CADT H2012 HA, H2012 HA CR, H2012 HA GT CR)
- Substance Abuse Intensive Outpatient Program (SAIOP H0015; H0015 AD; H0015 GT CR; H0015 AD GT CR; H0015 OT)
- Substance Abuse Comprehensive Outpatient Treatment (SACOT H2035; H2035 GT CR; H2035 OT)
- Ambulatory Detox (H0014, H0014 CR)
- Substance Abuse Non-Medically Monitored Community Residential (H0012 HB, H0012 HB CR)
- Substance Abuse Medically Monitored Community Residential (H0013, H0013 CR)
- Non-hospital Medical Detox (H0010, H0010 CR)
- Assertive Community Treatment Team (ACTT H0040, H0040 OT, H0040 DJ GT CR, H0040 DJ CR, H0040 GT CR, H0040 CR, H0040 DJ)
- Peer Support Services (PSS H0038 HQ; H0038 HK U4; H0038 HQ U4 DJ; H0038 U4 DJ; H0038 GTCR; H0038 DJ CR; H0038 CR; H0038 HQ DJ; H0038 HK; H0038 DJ; H0038 HQ GT CR; H0038 HQ CR; H0038 HQ IN; H0038 CR IN; H0038 IN; H0038 HQ DJ GR CR; H0038 HQ DJ CR; H0038 DJ GT CR)
- Community Support Team (CST H2015 HT HM CR; H2015 HT U1 CR; H2015 HT HN CR; H2015 HT HF CR; H2015 HT HO CR; H2015 HT HO CR; H2015 HT HM GT CR; H2015 HT U1 GT CR; H2015 HT HN GT CR; H2015 HT HF GT CR; H2015 HT HO GT CR; H2015 HT U1 DR CR; H2015 HT HF DJ CR; H2015 HT HO DJ CR; H2015 HT HM DJ CR; H2015 HT HN DJ CR, H2015 HT U1, H2015 HT HM, H2015 HT HN, H2015 HT HF, H2015 HT HO, H2015 HT U1 DJ, H2015 HT HM DJ, H2015 HT HN DJ, H2015 HT HF DJ, H2015 HT HO DJ)
- Comprehensive Clinical Assessment (CCA) is required for flex codes. CCA will be required for treatment beyond six months.
The following services, including Developmental and Psychological Testing codes provided via Telehealth will sunset on March 31, 2022.
- 96110 GTCR – Developmental Testing
- 96112 GTCR – Developmental Testing Administration and Scoring1st hour
- 96113 GTCR – Developmental Testing Administration and Scoring, additional 30 mins
- 96116 GTCR – Neurobehavioral Exam, 1st hour
- 96121 GTCR – Neurobehavioral Exam, each additional hour
The following testing codes will NOT sunset and can continue to be provided via Telehealth.
96130 GT – Psychological Evaluation and Interpretation– 1 hour
96131 GT– Psychological Evaluation and Interpretation– each additional 1 hour
96132 GT–Neuropsychological Evaluation, and Interpretation – 1 hour
96133 GT – Neuropsychological Evaluation and Interpretation, each additional 1 hour
The service below will continue to be reviewed at initial requests only during COVID-19 Public Health Emergency (PHE). Submit Notification SAR for reauthorization. However, staffing and program requirements will be sunsetting on March 31, 2022.
|FCT (Family Centered Treatment)
H2022 22 HE
|FCT will continue to be reviewed at initial requests only during COVID-19. Submit Notification SAR for reauthorization.
Allow supervision by team lead, or designee, to
Waive requirement that staff must be dedicated to the team.
Waive requirements that 60% of contacts should be face-to-face and 60% of staff time should be spent outside of facility.
Waive team-to-family ratio of 1:12.
Allow for supervision by any licensed professional on the team or employed by the provider agency, within scope and training, if Team Lead is sick or unavailable.
Changes to Outpatient Behavioral Health Services, including E/M codes have been made into permanent policy. Use Modifier GT for interactive audio-visual communication and KX via telephonic, audio-only. For more details, please see link below for Behavioral Health Clinical Coverage Policies: 8A, 8A-1, 8A-2, 8A-6, 8C, 8D-2 and 8G: https://medicaid.ncdhhs.gov/behavioral-health-clinical-coverage-policies
Research Based-Behavioral Health Treatment (RB-BHT) Changes:
- GTCR modifiers will be ending on 3/31/22.
- GT modifiers have been added as a permanent part of Clinical Coverage Policy 8F. GT modifier indicates that a service is being provided through two-way real time audio-visual telehealth. GT modifiers have been added for 97151, 97151 NC, 97152, 97152 NC, 97154, 97155, 97156, 97157. Existing GTCR authorizations will be transitioned to GT authorizations by UM with a start date of 4/1/2022. GT modifiers require prior authorization.
- KX modifiers have been added as a permanent part of Clinical Coverage Policy 8F. KX modifier denotes that services are provided telephonically. KX modifier will be added for 97156, 97157 effective 4/1/22. KX modifiers require prior authorization.
- KXCR modifiers will be added to 97151, 97151 NC, 97152, 97152 NC, 97153, 97154, 97155 effective 4/1/22. KXCR modifiers will be ending after the end of the Public Health Emergency. KXCR modifiers require a notification SAR be submitted.
- CR modifiers are continuing until the end at/after the Federal Public Health Emergency. CR modifier alone for RB-BHT “waive concurrent authorization under Medicare authorities.” CR modifiers require a notification SAR be submitted.
- Only base codes need to be reflected in the treatment plan. Base codes include: 97151, 97151NC, 97152, 97152NC, 97153, 97154, 97155, 7156, 97157.
If a provider would like to use the KX modifier, they must submit a Provider Change form to request that the codes be added to their contract. KXCR and GT will be automatically added to contracts for RB-BHT providers. https://providers.partnersbhm.org/provider-enrollment-credentialing/
Total hours approved in the treatment plan for the base code apply to all combinations of that RB-BHT code’s modifiers (i.e. GT, KX, KXCR). The KX, KXCR, and GT modifiers require prior authorization or notification SAR (as applicable) and can be authorized up to the amount authorized for the base code in the approved treatment plan. The combined claims for the base code and all applicable modifiers cannot exceed what is authorized by UM in the approved treatment plan. The provider will be required to repay the overage. As a reminder, authorization is not a guarantee of payment. Claims payment is dependent upon member funding eligibility during authorization period and contract of the service provider. Please review the example below:
A Member is authorized for 30 hours per week for 97153 (per the approved treatment plan and UM authorization).
Example 1. During the first week of March, the Member received:
|10||telehealth (97153 GT)|
|5||telephonic (97153 KXCR)|
|15||In person (97153)|
In Example 1, the member’s hours of authorized 97153 reached his/her maximum allowable.
Example 2. During the second week of March, the Member received:
|15||telehealth (97153 GT)|
|5||telephonic (97153 KXCR)|
|15||In person (97153)|
In Example 2, the member’s hours of authorized 97153 has collectively exceed his/her maximum allowable. If the provider submits claims and they adjudicate for all 35 hours, the provider will be required to repay 5 hours worth of services.