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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

State-by-State Worksheets Identify Medicaid Billing Opportunities for Integrated Care

September 3, 2014 | Integrated Care | Comments
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Financing is often perceived as one the biggest barriers to sustainable integration activities. By not billing at all, or billing incorrectly, providers risk denied or delayed claims payments, wasted time and resources, and missed reimbursement opportunities for services provided.

The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has updated its state billing worksheets, a tool to help clinic managers, integrated care project directors, and billing/coding staff identify the available current procedural terminology (CPT) codes they can use in their state to bill for services related to integrated primary and behavioral health care.

Community mental health centers and community health centers can use these worksheets to review these codes against all activities currently billed to ensure they are taking advantage of all potential billing opportunities to maximize revenue and sustain integrated care. CPT and diagnostic codes are consistent across the country; however, state Medicaid programs determine the types of services, codes, and individuals credentialed to provide services, resulting in unique billing rules and regulations in each state. The worksheets link CPT codes with the state-specific diagnostic codes and associated professional credentials needed to submit a successful, payable claim.

Changes to the updated worksheets include:

  • Updated CPT codes
  • States with services billable by peer support specialists
  • Updates to same-day billing allowances
  • New states with telemedicine codes
  • SBIRT Codes
  • Medicare obesity and tobacco counseling codes

Click to review the worksheet for your state.

CIHS reviewed source material from the state Medicaid offices to identify billing codes and credential requirements. When the information was not clearly available, CIHS contacted the state authorities directly to receive the source material for the updated codes.

Please note: Information in these worksheets is current as of July 2014. Billing codes may change as states change their Medicaid programs. Please verify the information with your state or local billing authorities if you have questions.