New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIII - Office of Mental Health › Part 599 - Clinic Treatment Programs › Section 599.14 - Medical assistance billing standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Medicaid claims for individuals who have
				been admitted to a Mental Health Outpatient Treatment and Rehabilitative
				Service program shall include, at a minimum, the Medicaid identification number
				of the individual, the designated mental illness diagnosis, the procedure code
				or codes corresponding to the procedure or procedures provided, the location of
				the service, specifically the licensed location where the service was provided
				or the clinician's regular assigned licensed location from which the clinician
				departed for an off-site procedure, and the National Provider Identification or
				equivalent Department of Health-approved alternative as appropriate of the
				attending clinician. The provider must also comply with the requirements
				associated with any procedure code being billed.
(b) Medicaid claims may be reimbursed for up
				to three pre-admission procedures per adult individual, excluding Peer/Family
				Support Services which has no pre-admission reimbursement limit, no more than
				one of which may be a collateral procedure. For children, claims may be
				reimbursed for up to three pre-admission visits per child/family, excluding
				visits solely for Peer Support Services. For pre-admission visits at least the
				code for unspecified Illness must be entered on the claim.
(c) Medicaid claims may be submitted for no
				more than three services, comprising of two psychiatric services and one
				health service, per day for any individual, not including crisis intervention,
				complex care management, peer support services, or any services that are
				provided as part of IOP. For the purposes of this subdivision, psychotropic
				medication treatment, injectable psychotropic medication administration,
				injectable psychotropic medication administration with monitoring and
				education, and complex care management services may be counted as either health
				services or psychiatric services. No more than one health physical may be
				claimed in one year.
(d) Billing
				services.
(1) Assessment services consist of
				two types of assessment--Initial Assessment and Psychiatric Assessment. No more
				than three initial assessment procedures may be reimbursed by Medicaid.
				Additional initial assessment procedures are eligible for Medicaid
				reimbursement when more than 365 days have transpired since the most recent
				Medicaid reimbursed visit to the Mental Health Outpatient Treatment and
				Rehabilitative Service program.
(i) initial
				assessment Services shall include performance or consideration, as applicable,
				of the Health Screening.
(ii) The
				Mental Health Outpatient Treatment and Rehabilitative Service program must
				document a minimum of 45 minutes face-to-face contact with the individual or
				family or other collaterals. For school-based services, the duration of such
				services may be that of the school period, provided the school period is of a
				duration of at least 40 minutes.
(iii) Mental Health Outpatient Treatment and
				Rehabilitative Service programs may bill the physician modifier when
				psychiatrists, nurse practitioners in psychiatry, or physicians approved
				pursuant to Section
				599.9  of this Part spend at least
				15 minutes serving the individual during the time the initial assessment is
				being conducted by another licensed practitioner.
(iv) A Psychiatric Assessment may be provided
				to either an individual being assessed for admission to the Mental Health
				Outpatient Treatment and Rehabilitative Service program, or an individual who
				is currently admitted. Psychiatric assessments may be performed for admitted
				recipients where medically necessary without limitations. Psychiatric
				Assessments may include such elements as a diagnostic interview and treatment
				plan development.
(a) A Psychiatric
				Assessment may be provided by a physician, psychiatrist, nurse practitioner in
				psychiatry, or physician assistant with specialized training approved by the
				Office to an individual who has been admitted to the Mental Health Outpatient
				Treatment and Rehabilitative Service program, or one for whom the
				appropriateness of admission is being assessed.
(b) A Psychiatric Assessment of at least 30
				minutes of documented face-to-face interaction between the individual, or
				family or other collaterals, and the physician, psychiatrist, or nurse
				practitioner in psychiatry, shall be billed as a Brief Psychiatric
				Assessment.
(c) A Psychiatric
				Assessment of at least 45 minutes of documented face-to-face interaction
				between the individual, or family or other collaterals, and the physician,
				psychiatrist or nurse practitioner in psychiatry, shall be billed as an
				Extended Psychiatric Assessment.
(d) Programs shall comply with the most
				recent applicable AMA coding guidelines regarding the appropriate use of
				evaluation and management codes for Psychiatric Assessment services, including
				minimum duration standards for the provision of psychotherapy services provided
				by physicians and nurse practitioners. Where clinically appropriate and
				consistent with applicable AMA coding guidelines for service duration ranges
				for evaluation and management codes, programs may bill for Brief or Extended
				Psychiatric Assessments for shorter service durations than those specified in
				this subparagraph.