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H0031 & H0032 modifier/unit changes as of 01/01/2019

Jonathan Beulke 1 year ago in Billing/Electronic Modules updated 1 year ago 10

I received notification that codes H0031 & H0032 will only be able to be billed as 1 unit and must have the modifier "UD" removed as of 01/01/2019.  MHCP posted a bulletin about these changes:

"The Centers for Medicare & Medicaid Services (CMS) has established a Medically Unlikely Edits (MUEs) of one unit for HCPC codes H0031 (mental health assessment by non-physician) and H0032 (mental health service plan development by non-physician) beginning Jan. 1, 2019. MUEs prevent payment for an inappropriate quantity of the same service on a single day. Currently, more than one unit is allowed for each of these codes when the UD modifier is included. The UD modifier will no longer be required and only one unit of each of these services will be allowed per day for Managed Care Organizations (MCOs) and fee-for-service claims beginning Jan. 1, 2019. Minnesota Health Care Programs (MHCP) will deny a claim line that includes more than one unit. MHCP will determine a per-session rate for H0031 and H0032 and will reprocess paid claims with dates of service beginning Jan. 1, 2019, once a new rate is established. (pub. 12/28/18, rev. 1/8/19)"

Since our claims are currently being denied, I contacted MN-ITS provider help desk to inquire about this.  Essentially they have no answer as to when the rate for 1 unit will be decided, or what that rate will be.

Has anyone come up with a decent conclusion how to bill for these properly?  Provider help desk did say they will automatically resubmit all claims that contain 1 unit.

Thanks in advance

We set our rate as the equivalent of the previous rate for 6 units. That way, we are safe in assuming we will have billed enough - once they decide their rate. The most recent bulletin from DHS has a rate listed for the H0031 & H0032 for $82+. DHS has stated they are going to come up with a rate, pay it, and then reimburse later if they decide the rate should be more. This rate had disclaimers, so I don't think this is necessarily the true rate. That's all I have seen so far.

Thanks,

Sarah

Thank you Sarah,

Is it possible to send me the link to this most recent bulletin?  I'm unable to locate it anywhere on the MHCP website.  

Also, are you assigning 6 units worth of rate to H0031, or H0032, or both?  It's my understanding H0031 is allowed 24 units/year, and that is typically billed only twice per year, and H0032 is allowed 14 units per year, which we bill quarterly.  

In my thinking, I want to do it this way: 

Evenly divide the units for H0031 over 2 events, equalling $259.68 per event.  

Evenly divide the units for H0032 over 4 events, equalling $75.74 per event.  

Or are you feeling that CMS is thinking they are paying out too much for these codes?  I just want to make sure our MHPs get the reimbursement they are deserving of.

Thanks!

https://mn.gov/dhs/partners-and-providers/news-initiatives-reports-workgroups/minnesota-health-care-programs/provider-news/

There is the link for MHCP Provider News.  Not much is to be said for the H0031 and H0032 codes.  I appreciate Sarah's comment above on how their fee schedule has been restructured.  The most recent ARMHS provider Web Ex spoke to the H0031 and H0032 changes as well. 

I just got off the phone with Amerigroup (Blue Plus) and they are reprocessing our H0031, H0032, H0031 TS, H0032 TS and H0032 UA billing. They were reimbursing at $21.02 and that is the equivalent of the previous 15 min. unit. Wanted to let you all know, in case you are not being reimbursed correctly. It sounded like these codes should be reimbursing closer to $80.

Is this for your CTSS services? If not, what program?

The H0032 UA is CTSS - Treatment Plan Development code. The rest of the codes we bill through our ARMHS Program. Sorry!

Wow, if they ultimately only pay $21.02, that ridiculous. How can a payer expect anyone to do an adequate job completing FA's and ITP's for that amount or in 15 minutes?

Jonathan, I believe it is because of the MA change. We used to be able to bill up to 15 units (each unit being 15 minutes) per year, but MA decided they wanted the code billed as one unit (one session being one unit). 


We were originally afraid to change all of our H0031 and H0032 billing all at once, thinking the PMAP's wouldn't change over as quickly as MA did. It appears that is how this BluePlus PMAP processed - thinking we were billing the previous 15 min. unit - not the current one session unit. 


I was happy they had it already set up correctly, when I called to have them reprocessed - but I don't know that they would have reprocessed without us asking. Wanted to be sure I told anyone I could - so they can also contact them to have their codes/billing reprocessed so they pay correctly. :)

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Just got off the phone with DHS.  They are now paying for one unit per day.  These are now session codes.  The rate is 86 something per session. They are going to do some kind of payments for denied codes in their systems.  PMAPs are going to be a mess to clean up as I see they are still paying by unit.

Thanks for the update.  We have been noticing the payments as $86.56 per unit.

Did DHS mention anything about the number of allowable units per year for these?