California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 1 - Department of Mental Health › Chapter 11 - Medi-Cal Specialty Mental Health Services › Subchapter 4 - Federal Financial Participation › Article 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.304 - Crosswalk Between Service Functions and HCPCS Codes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When an
					 individual or group provider bills and is paid by the MHP for psychiatrist,
					 psychologist, or EPSDT supplemental specialty mental health services using CPT or
					 other HCPCS codes, the MHP shall claim FFP by service function based on a crosswalk
					 between allowable CPT and other HCPCS codes and service functions established by the
					 Department pursuant to the contract between the MHP and the Department. The dollar
					 amount claimed shall be in accordance with Section
					 1840.105.
(b) When a provider that is a hospital outpatient
					 department bills and is paid by the MHP for facility room use using the HCPCS codes
					 Z7500 or Z7502 in addition to the CPT or other HCPCS code for the specialty mental
					 health service provided to the beneficiary, the MHP shall claim FFP for the combined
					 codes under the CPT or other HCPCS codes for the specialty mental health service
					 provided to the beneficiary that are listed on the crosswalk established pursuant to
					 the contract between the MHP and the Department as specified in Subsection (a). When
					 a provider bills the MHP using a CPT or other HCPCS code that is not included on the
					 crosswalk established pursuant to the contract between the MHP and the Department as
					 specified in Subsection (a) other than Z7500 or Z7502, the MHP shall determine the
					 appropriate service function for the service provided and shall claim FFP in
					 accordance with Section
					 1840.308.
(c) The HCPCS codes listed on the crosswalk
					 established pursuant to the contract between the MHP and the Department as specified
					 in Subsection (a) may be billed by any individual or group providers acting within
					 the scope of their practice.
(d) The
					 lockouts described in Section
					 1840.215 and Sections
					 1840.360 through
					 1840.374 shall apply to claiming of FFP
					 for services claimed under this Section. For the purpose of determining lockouts the
					 service shall be considered to be the service function identified on the crosswalk
					 established pursuant to the contract between the MHP and the Department as specified
					 in Subsection (a).
(e) The crosswalk
					 established pursuant to the contract between the MHP and the Department as specified
					 in Subsection (a) shall not be used to claim FFP for services provided by
					 organizational providers.
1. New section
						filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A
						Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language
						will be repealed by operation of law on the following day.
2. New section
						refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A
						Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency
						language will be repealed by operation of law on the following day.
3.
						New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No.
						25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate
						of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be
						repealed by operation of law on the following day.
4. Editorial
						correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction
						extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50
						(Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any
						other provision of law, emergency regulations adopted pursuant to Welfare and
						Institutions Code section
						14680
						to implement the second phase of mental health managed care as provided in this part
						shall remain in effect until permanent regulations are adopted, or June 30, 2006,
						whichever occurs first.
6. Editorial correction of HISTORY 5 (Register
						2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new
						section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
Note: Authority cited: Section
						  14680,
						  Welfare and Institutions Code. Reference: Section
						  5778,
						  Welfare and Institutions Code.