Mental Health Services

Washington Apple Health (Medicaid)

Mental Health Services Billing Guide

July 1, 2019

Every effort has been made to ensure this guide's accuracy. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply.

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About this guide*

This publication takes effect July 1, 2019, and supersedes earlier guides to this program. HCA is committed to providing equal access to our services. If you need an accommodation or require documents in another format, please call 1-800-562-3022. People who have hearing or speech disabilities, please call 711 for relay services.

Washington Apple Health means the public health insurance programs for eligible Washington residents. Washington Apple Health is the name used in Washington State for Medicaid, the children's health insurance program (CHIP), and stateonly funded health care programs. Washington Apple Health is administered by the Washington State Health Care Authority.

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What has changed?

Subject Behavioral Health Organizations

Integrated managed care regions

Crisis services in Part I Outpatient Mental Health Services Coverage Table

Change Removed the North Sound region

Effective July 1, 2019, a new integrated managed care region, called North Sound, will be implemented. North Sound region includes Island, San Juan, Skagit, Snohomish, and Whatcom counties. Added a note that for authorizations, the provider must call the BH-ASO, which is the crisis line for the county. Revised limits to the following CPT codes: 90845, 90849, and 90865.

Reason for Change Effective July 1, 2019, behavioral health services in the North Sound region will be provided under integrated managed care New integrated managed care region

Clarification

Clarification

Outpatient Mental Health Services Coverage Table

Removed CPT codes 99356 and 99357.

Psychological testing and evaluation services

Removed blue note box under this section which referred to evaluations done by a COE for a child suspected of having autism spectrum disorder and requiring the use of EPA code 870001315 with modifier UC.

Codes belong in Inpatient Mental Health Services Coverage Table. They were incorrectly also in the Outpatient Mental Health Services Coverage Table. This EPA code is removed from this guide because the lifetime limit for psychological testing is now 9 units for any combination of psychological testing codes. See CPT Code 96130.

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Subject CPT codes for inpatient professional services provided to an MCO client during a BHOauthorized admission Inpatient Mental Health Coverage Table

CPT code 96110

Change Updated the list of CPT codes in the blue note box.

Added these CPT codes: 99251, 99252, 99253, 99254, 99255, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 96132, 96133, 96112, 96113 Deleted this code from Part II: High acuity services for AI/AN fee-for-service clients.

Reason for Change These codes were missing from the list.

These codes were missing from the list.

This code is no longer valid for testing. The code is valid for screening. High acuity services, the services in Part II, do not require the screening codes.

How can I get agency provider documents?

To access provider alerts, go to the agency's provider alerts webpage.

To access provider documents, go to the agency's provider billing guides and fee schedules webpage.

Where can I download agency forms?

To download an agency provider form, go to HCA's Billers and providers webpage, select Forms & publications. Type the HCA form number into the Search box as shown below (Example: 13-835).

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Copyright disclosure

Current Procedural Terminology (CPT) copyright 2018 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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