SMHS Billing Manual changes

New Content

• 4.1.19- Community Based Mobile Crisis Intervention Services
  • Mobile crisis intervention services provide rapid response, individual assessment and community-based stabilization for Medi-Cal beneficiaries who are experiencing a mental health crisis.
• HQ modifier added- Group setting Modifier
• New Service Codes
• H2011 – Mobile Crisis Intervention
• H0025 - Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)
• H00380- Self-help/peer services per 15 minutes

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  99221-Initial hospital care, per day, for the evaluation and management of a patient. Usually, the problem(s) requiring admission are of low severity. 20-39 minutes
• 99222-Initial hospital care, per day, for the evaluation and management of a patient. Usually, the problem(s) requiring admission are of moderate severity. 40-59 mins
• 99223-Initial hospital care, per day, for the evaluation and management of a patient. Usually, the problem(s) requiring admission are of high severity. (60-79 mins)

Updates Content

• 5.3.2- Beneficiary Gender The beneficiary’s gender needs to be reported on the claim but will not be verified by SD/MC as of 7-1-2023.
  • The previous version the service would deny if the beneficiary’s gender did not match MEDS Service.
• 5.4.0- Exception added for psychiatric inpatient hospital services Same same month for the first day of the following month.
• For any single claim, all dates of service must be within the same calendar month, except for claims for psychiatric inpatient hospital services. The discharge date on the claim for psychiatric inpatient hospital services may occur on the first day of the following month
• 5.16.0 Telehealth modifier exception for Mobile Crisis.
  • If a telehealth modifier is used, the place of service code must be 02 or 10 unless the service is mobile crisis. SD/MC will deny service lines for services that have a telehealth modifier but are not in place of service 02 or 10 unless the service is mobile crisis.    
• 5.23.0- Added services that are billed directly to Medi-Cal
  • Services H0025 and H0038 -  Peer support services
    • H2011 with POS 15: Mobile Crisis
• 5.27.0- Emergency Indicator removed from section
  • Now only Pregnancy Indicator
• 6.1.0- FMAP Percentage and Aid codes removed Emergency Indicator
  • This section only refers to Pregnancy Indicator now.

Minor changes

• 4.2.0- Tables referenced changed from 1-11 to 1-12

Assessment codes

New lockout codes

This table will show only the new/changed Lockout code.