With the growing number of commercially insured children receiving mental health services from state-funded community-based organizations, we are reminding participating practitioners that many services they provide can be billed under a child’s Harvard Pilgrim Health Care Commercial plan.
If you are a provider who treats children with severe mental illness through one of New Hampshire’s 10 Community Mental Health Centers (CMHCs), you may be able to bill for services that encompass:
- Crisis assessment, intervention, and stabilization
- In-home services
- Residential treatment
- Structured outpatient programs
- Care coordination
- Parent and youth peer support
- Hospital-based, non-residential treatment
Many of these services qualify as health care services that can be billed using Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, along with the appropriate modifiers.
The reference chart on pages 4-7 of the New Hampshire Bulletin identifies common billing codes that are associated with this category of services. Because billing codes and categories vary by payor, however, it is important for providers to refer to Point32Health’s Behavioral Health and Substance Use Disorder Payment Policy before submitting claims for CMHC services.
While prior authorization for CMHC services is not required, notification of admission to a community crisis stabilization or acute residential treatment program within a CMHC must be provided within two business days. Refer to Point32Health’s Behavioral Health Inpatient and 24 Hour Level of Care Determinations Medical Necessity Guidelines for more information.
Upon admission to a partial hospitalization program, notification is required within one calendar day. Additional information can be found within Point32Health’s Behavioral Health Level of Care for Non 24 Hour/Intermediate/Diversionary Services Medical Necessity Guidelines.
Annmarie Dadoly,
Senior Manager, Provider Communications
Joseph O’Riordan,
Editor
Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,
Writers
Kristin Edmonston,
Production Coordinator
Kristina Cicelova,
Graphic Designer