New York State Children’s Health and Behavioral Health ...

New York State Children's Health and Behavioral Health Medicaid System

4 Transformation er 202 Billing and Coding Manual

ptemb September 2022 ed Se Send questions to ArchivBH.Transition@health.

New York State Children's Health and Behavioral Health Services Billing and Coding Manual

Table of Contents

Table of Contents...................................................................................................................... 2 General..................................................................................................................................... 6

Purpose of this Manual .......................................................................................................... 6 Children and Family Treatment and Support Services (CFTSS) .............................................. 7

4 Children's Home and Community Based Services (HCBS)...................................................... 7 2 Health Home Care Management ............................................................................................ 8 0 Additional State Plan Behavioral Health (BH) Services ........................................................... 8 2 Services Included in or Excluded from Capitation Payments to Medicaid Managed Care Plans 9 r Fundamental Requirements..................................................................................................... 10 e Provider Designation to Deliver Services .............................................................................. 10 b Services that do not require State Designation ..................................................................... 11 m Medicaid-Enrolled Provider .................................................................................................. 11 te Medicaid Managed Care Plan Contracting............................................................................ 11

Rates ...................................................................................................................................... 13

p Government Rates............................................................................................................... 13 e Productivity Adjustment........................................................................................................ 13 S Regions............................................................................................................................... 13

Claims..................................................................................................................................... 14

d General Claim Requirements ............................................................................................... 14 e Enrollment Status ................................................................................................................ 14 iv Medicaid Fee-For-Service Claiming (eMedNY) ..................................................................... 14 h Medicaid Managed Care Plan Claiming ................................................................................ 15 c Multiple Services Provided on the Same Date to the Same Child/Youth ................................ 16 Ar Services Provided While in Transit ....................................................................................... 16

Submitting Claims for Services When the Child/Youth is Not Present.................................... 16 Services Delivered by Multiple Staff Members ...................................................................... 17 Submitting Claims for Non-Sequential Time for the Same Service, on the Same Day ............ 17 Timed Units per Encounter of Service................................................................................... 18 Submitting Claims for Daily Billed Services........................................................................... 18 Claims Coding Table............................................................................................................ 18

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New York State Children's Health and Behavioral Health Services Billing and Coding Manual

Claims Testing..................................................................................................................... 19 Claiming Information for Medicaid EPSDT Children and Family Treatment and Support Services and Children's Home and Community Based Services ............................................................. 20

Service Combinations .......................................................................................................... 20 Provider Assistance................................................................................................................. 23 Where to Submit Questions and Complaints ............................................................................ 24 Children and Family Treatment and Support Services (CFTSS)................................................ 25

4 Other Licensed Practitioner (OLP)........................................................................................ 25 2 OLP ? Licensed Evaluation .................................................................................................. 26 0 OLP ? Counseling................................................................................................................ 27 2 OLP - Individual and/or Family Counseling ........................................................................... 27

OLP ? Group Counseling ..................................................................................................... 27

r Crisis Under OLP................................................................................................................. 28 e OLP - Crisis Off-site............................................................................................................. 28 b OLP - Crisis Triage (by telephone) ....................................................................................... 28 m OLP - Crisis Complex Care (follow-up to Crisis).................................................................... 28 te Community Psychiatric Support and Treatment (CPST) ........................................................ 29

CPST - Service Professional ? Individual and/or Family........................................................ 29

p CPST - Service Professional - Group ................................................................................... 29 e Psychosocial Rehabilitation (PSR) ....................................................................................... 30 S PSR - Service Professional - Individual................................................................................. 30

PSR - Service Professional ? Group..................................................................................... 30

d Family Peer Support Services (FPSS).................................................................................. 30 e FPSS Service Professional - Individual................................................................................. 31 iv FPSS Service Professional - Group...................................................................................... 31 h Youth Peer Support (YPS) ................................................................................................... 31 c YPS Service Professional - Individual................................................................................... 32 Ar YPS Service Professional - Group........................................................................................ 32

Crisis Intervention ................................................................................................................ 32 Crisis Intervention ? One Licensed ....................................................................................... 33 Crisis Intervention ? Two Person Response: Licensed and Unlicensed/Certified Peer ........... 33

Crisis Intervention ? Two Person Response: Both Licensed (up to 90 minutes) ..................... 33 Crisis Intervention ? Two Person Response: Both Licensed (90-180 minutes)....................... 34 Crisis Intervention - Two Person Response: Both Licensed (over 180 minutes)..................... 34

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New York State Children's Health and Behavioral Health Services Billing and Coding Manual

Two Person Response: Licensed and Unlicensed/Certified Peer (90-180 minutes)................ 34 Two Person Response: Licensed and Unlicensed/Certified Peer (over 3 hours) .................... 34 Crisis Intervention Mobile and Telephonic Follow up............................................................. 35 Children's Home and Community Based (HCBS) Services ....................................................... 35 Prevocational Services......................................................................................................... 35 Caregiver/Family Advocacy and Support Services................................................................ 36 Supportive Employment....................................................................................................... 37

4 Palliative Care Pain and Symptom Management................................................................... 37 2 Palliative Care Counseling and Support Services.................................................................. 37 0 Palliative Care Massage Therapy......................................................................................... 38 2 Palliative Care Expressive Therapy...................................................................................... 38 r Respite................................................................................................................................ 39 e Day Habilitation.................................................................................................................... 40 b Community Habilitation ........................................................................................................ 41

Environmental Modifications................................................................................................. 43

m Vehicle Modifications ........................................................................................................... 46 te Adaptive and Assistive Technology....................................................................................... 48

Non-Medical Transportation ................................................................................................. 51

p Health Home Care Management.............................................................................................. 52 e Behavioral Health (BH) State Plan Services ............................................................................. 53 S Appendix A ? Children and Family Treatment and Support Services Rate Code Descriptions ... 54 d Other Licensed Practitioner.................................................................................................. 54 e OLP Counseling (Family and Individual) Fee-for-Service billing Only..................................... 55 iv Community Psychiatric Support and Treatment .................................................................... 56

Psychosocial Rehabilitation.................................................................................................. 56

h Family Peer Support Services .............................................................................................. 56 rc Youth Peer Supports............................................................................................................ 57 A Crisis Intervention ................................................................................................................ 57

Appendix B ? Aligned HCBS Rate Code Descriptions .............................................................. 59 Pre-Vocational Services....................................................................................................... 59 Caregiver/Family Advocacy and Support Services................................................................ 59 Supported Employment........................................................................................................ 60 Palliative Care Pain & Symptom Management...................................................................... 60 Palliative Care Counseling and Support Services ................................................................. 61

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New York State Children's Health and Behavioral Health Services Billing and Coding Manual

Palliative Care ? Bereavement Services............................................................................... 61 Palliative Care Massage Therapy ......................................................................................... 62 Palliative Care Expressive Therapy ...................................................................................... 62 Respite ? Planned................................................................................................................ 62 Respite ? Crisis.................................................................................................................... 63 Day Habilitation.................................................................................................................... 63 Community Habilitation ........................................................................................................ 63

4 FFS Billing for Environmental Modifications (E-Mods), Vehicle Modifications (V-Mods), and 2 Adaptive and Assistive Technology (AT)............................................................................... 64 0 MMC Billing for Environmental Modifications (E-Mod), Vehicle Modifications (V-Mod), and

Adaptive and Assistive Technology (AT) ............................................................................... 64

2 Environmental Modifications................................................................................................. 65 r Vehicle Modifications ........................................................................................................... 65 Archived Septembe Adaptive and Assistive Technology ...................................................................................... 65

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