Mental Health Billing



|Type of Insurance |

|Full-Scope (FFS) Medi-Cal |Patient arrives already enrolled. |NOT a confidential visit. |No limitations regarding |Yes |Yes |

| | |Parental consent required |topics/number of visits? | | |

| | | | | | |

| | |Parents will NOT be made aware of sensitive services | | | |

| | |that are provided. | | | |

|Full-Scope Managed Care Medi-Cal (i.e. Alameda|Patient arrives already enrolled (usually |NOT a confidential visit. |No limitations regarding |Yes |Yes |

|Alliance or Blue Cross) |what people mean when they say they have |Parental consent required |topics/number of visits? | | |

| |‘Medi-Cal’) | | | | |

| | |Parents will NOT be made aware of sensitive services | | | |

| | |that are provided. | | | |

|Temporary Gateway Medi-Cal |Clinic can enroll patient if they have no |NOT a confidential visit. |No limitations regarding |Yes |Yes |

| |insurance and are eligible. Clinic can see |Parental consent required |topics/number of visits | | |

| |them for all services beginning the first day| |Can bill for unlimited visits within | | |

| |of the month within which they are |Parents will NOT be made aware of sensitive services |the 31-60 day period. | | |

| |registered, through the end of the following |that are provided. | | | |

| |month (up to 60 days). | | | | |

| | | | | | |

|Medi-Cal Minor Consent/Sensitive Services - |Clinic enrolls patient. |CONFIDENTIAL VISIT |No limitations regarding number of |No |Yes |

|outpatient mental health (7P) | | |visits? | | |

| |It doesn’t matter what primary insurance they|If parents come in for family therapy, cannot bill that| | | |

| |might have |portion of that visit under Minor Consent Medi-Cal. |Visit content and charting | | |

| | | |documentation must support the | | |

| |Have to either a) present an danger of | |assessment that determines that | | |

| |causing serious physical or mental harm to | |patient will “present a danger of | | |

| |self or others without mental health | |causing serious physical or mental | | |

| |treatment or counseling OR b) be an alleged | |harm to self or others without mental| | |

| |victim of incest or child abuse.  | |health treatment or counseling OR b)| | |

| |Attach letter to enrollment form stating | |be an alleged victim of incest or | | |

| |such. | |child abuse.” | | |

|Medi-Cal Minor Consent/Sensitive Services (7M)|Clinic enrolls patient. |CONFIDENTIAL VISIT |Visits DO need to relate to STDs, |Yes |No |

|– sensitive services (STDs, family planning, | | |family planning, sexual assault or | | |

|sexual assault, drug/alcohol abuse) |It doesn’t matter what primary insurance they|If parents come in for family therapy, cannot bill that|drug & alcohol abuse specifically | | |

| |might have |portion of that visit under Minor Consent Medi-Cal. | | | |

| | | |The diagnosis code needs to match the| | |

| |For behavioral health services must have a | |primary or secondary diagnosis code | | |

| |referral from the PCP relating specifically | |used by the PCP. | | |

| |to the sensitive service topic (STDs, family | | | | |

| |planning, sexual assault or drug/alcohol | | | | |

| |abuse) | | | | |

| |

|Licensed AND Unlicensed Providers |

|FamilyPACT |Clinic enrolls patient. |CONFIDENTIAL VISIT |Visits DO need to relate specifically|Yes |No |

| | | |to sexual health. | | |

| |FPACT does not cover mental health business | | | | |

| |per se, but covers health education visits | |FPACT has limit of 2 visits/month | | |

| |regardless of licensure of provider. If you | |(including other providers). | | |

| |cannot bill under any other insurance AND you| | | | |

| |cover sexual health as part of your visit, | | | | |

| |you can bill FPACT for the visit. | | | | |

|HealthPAC |Patient arrives already enrolled. |NOT a confidential visit. |No limitations regarding |Yes |Yes |

| | |Parental consent required |topics/number of visits | | |

| | | | | | |

| | |Parents will NOT be made aware of sensitive services | | | |

| | |that are provided. | | | |

|Victims Of Crime |Patient and family can fill out application |Both confidential and non-confidential visits are |No limitations regarding |Yes |Yes |

| |after making a police report or obtaining a |covered? |topics/number of visits | | |

| |copy of a police report made. | | | | |

| | | | | | |

| |Provider needs to be registered with VoC. | | | | |

NOTE: only one appointment per patient can be billed per day regardless of provider.

961XX codes (Health and Behavior) are to be used for referrals from PCP for behavioral health visits related to medical reasons. Chart documentation must link to the medical visit and the medical reason for referral. Example: Help patient manage their X symptoms or behaviors (depressive symptoms, anger, relationship) so they can better manage their Y reason for visit with medical provider (e.g., dietary changes, birth control, risk reduction, medication adherence). Diagnosis must be the same as Medical diagnosis as the diagnosis given by the PCP.

908XX codes (Mental Health Counseling) are to be used for mental health appointments. Chart documentation must document mental health assessment, intervention and diagnosis.

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