Point32Health would like to inform our network providers that we’ve clarified the behavioral health (BH) boarding billing requirements outlined in the Point32Health Emergency Department Services and Observation Stay Payment Policies, as well as the Tufts Health Plan Inpatient Facility Payment Policy.
Tufts Health Direct billing instructions and update
When billing for BH boarding for Tufts Health Direct members, you can submit procedure code S9485 on the same claim as the inpatient stay, observation stay, or emergency room visit and will be reimbursed separately for BH boarding services as a carve-out payment. For dates of service on or after Oct. 1, 2024 for Tufts Health Direct, providers are no longer required to bill for BH boarding on a separate claim. Please keep in mind that claims for BH boarding should include admission type “Urgent,” “Emergency,” or “Trauma Center” as applicable for proper reimbursement.
In addition, it’s important to note that facility claims submitted with code S9485 are limited to one unit per day and one bill per hospital stay for the member. As a reminder, when used for BH boarding, S9485 cannot be billed on the same date of service as a claim billed with S9485 with modifiers V1 or V2 for the same member for crisis intervention.
For complete billing instructions, please refer to the updated Payment Policies.