BILLING CHANGE FOR BEHAVIORAL HEALTH ENCOUNTERS - EFFECTIVE DECEMBER 1, 2022
Date: 11/30/22
This notice is to inform Encounter Rate Clinics (ERCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs) of a change in billing to identify behavioral health encounters.
Effective with dates of service beginning December 1, 2022, providers must use procedure code T1040 – Medicaid Certified Community Behavioral Health Clinic Services, Per Diem, instead of the procedure code T1015. Providers must also continue to utilize the following modifiers:
- Modifier AJ = Licensed Clinical Social Worker
- Modifier AH = Licensed Clinical Psychologist
- Modifier HO = Licensed Clinical Professional Counselor or Licensed Marriage and Family Therapist
The behavioral health encounter reimbursement rates will remain the same.
FQHCs and RHCs can bill medical services using procedure code T1015 with no modifier and T1040 with an applicable behavioral health modifier for the same customer, same date of service.
ERCs can bill medical services using procedure code T1015 with no modifier and T1040 with an applicable behavioral health modifier but not for the same date of service. Encounter rate clinic payment policy does not allow billing of both a medical encounter and a behavioral health encounter on the same date.
Why the change?
Currently the procedure code T1015 – Clinic Visit/Encounter, All-Inclusive is used to bill both physical and behavioral health encounters, with behavioral health encounters differentiated through the modifiers above.
Changing the procedure code to T1040 is necessary to align with the Centers for Medicare & Medicaid Services’ (CMS) Medically Unlikely Edits (MUEs) policy for T1015, which does not allow for both a medical and a behavioral health encounter to be billed on the same day without the exception approval from CMS.
If you have any questions, please get in touch with provider relations at Provider Relations Intake.
Source: Illinois Department of Healthcare and Family Services