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  • Medicaid Billing Rates

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    Mistor Williams
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    This document lists service rates for various Medicaid HCSPCS MH/DD/SA services in North Carolina. It provides the service code, description, billing unit, rate, and effective date for services including non-hospital medical detoxification, SA non-medical community residential treatment, opioid treatment, targeted case management for mental health and substance abuse, partial hospitalization, peer support services, assertive community treatment teams, mobile crisis management, and more. The rates shown do not guarantee coverage and providers should check Medicaid billing guides and clinical coverage policies for covered services.

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    MEDICAID BILLING RATES

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    This document lists service rates for various Medicaid HCSPCS MH/DD/SA services in North Carolina. It provides the service code, description, billing unit, rate, and effective date for services including non-hospital medical detoxification, SA non-medical community residential treatment, opioid treatment, targeted case management for mental health and substance abuse, partial hospitalization, peer support services, assertive community treatment teams, mobile crisis management, and more. The rates shown do not guarantee coverage and providers should check Medicaid billing guides and clinical coverage policies for covered services.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    11 views1 page

    Medicaid Billing Rates

    Uploaded by

    Mistor Williams
    This document lists service rates for various Medicaid HCSPCS MH/DD/SA services in North Carolina. It provides the service code, description, billing unit, rate, and effective date for services including non-hospital medical detoxification, SA non-medical community residential treatment, opioid treatment, targeted case management for mental health and substance abuse, partial hospitalization, peer support services, assertive community treatment teams, mobile crisis management, and more. The rates shown do not guarantee coverage and providers should check Medicaid billing guides and clinical coverage policies for covered services.

    Copyright:

    © All Rights Reserved
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    MEDICAID HCSPCS MH/DD/SA Service Rates

    The inclusion of a rate on this table does not guarantee that a service is covered. Please refer to the Medicaid Billing Guide and the Medicaid and
    Health Choice Clinical Coverage Policies on the DHB Web site.
    SERVICE
    RATE FOR EFFECTIVE
    CODE with MH/DD/SA ENHANCED BENEFITS SERVICE DESCRIPTION BILLING UNIT
    SERVICE DATE
    MODIFIERS

    H0010 Non-Hospital Medical Detoxification per diem $ 325.58 7/1/2012


    H0012 HB SA Non-Medical Community Residential Treatment per diem $ 155.81 7/1/2012
    H0013 SA Medically Monitored Community Residential Treatment per diem $ 241.81 7/1/2012
    H0014 Ambulatory Detoxification 15 minutes $ 21.25 7/1/2012
    H0015 Substance Abuse Intensive Outpatient Program per diem $ 133.72 3/1/2022
    H0019 HQ High Risk Intervention - Level III - 4 Beds or Less per diem $ 253.62 3/1/2022
    H0019 TJ High Risk Intervention - Level III - 5 Beds or More per diem $ 210.49 3/1/2022
    H0019 HK High Risk Intervention - Level IV - 4 Beds or Less per diem $ 341.63 3/1/2022
    H0019 UR High Risk Intervention - Level IV - 5 Beds or More per diem $ 341.63 3/1/2022
    H0020 Opioid Treatment per event $ 16.60 7/1/2012
    H0032 Targeted Case Management - Mental Health / Substance Abuse per week $ 81.25 7/1/2010
    H0035 Partial Hospital per diem $ 135.20 3/1/2022
    H0038 Peer Support Services (Individual) 15 minutes $ 12.51 3/1/2022
    H0038 HQ Peer Support Services (Group) 15 minutes $ 3.02 3/1/2022
    Event, maximum
    H0040 Assertive Community Treatment Team (ACTT) 4 per month $ 295.32 7/1/2012
    H0046 ## High Risk Intervention - Level I per diem $ 56.23 3/1/2022
    H2011 Mobile Crisis Management 15 minutes $ 90.00 7/1/2021
    H2012 HA Child and Adolescent Day Treatment per hour $ 32.13 3/1/2022
    H2015 HT Community Support Team 15 minutes $ 26.45 3/1/2022
    H2017 Psychosocial Rehabilitation 15 minutes $ 2.87 3/1/2022
    H2020 ## High Risk Intervention - Level II Group Homes per diem $ 140.13 3/1/2022
    H2022 Intensive In-Home Services per diem $ 239.66 10/1/2014
    H2033 Multi-Systemic Therapy (MST) 15 minutes $ 36.57 7/1/2012
    H2035 SA Comprehensive Outpatient Treatment Program per hour $ 46.07 3/1/2022
    S5145 ## High Risk Intervention - Level II Family Setting per diem $ 97.22 3/1/2022
    S5145 HA Intensive Alternate Family Treatment per diem $ 231.28 3/1/2022
    S9484 Professional Treatment Services in Facility Based Crisis per hour $ 30.00 7/1/2021
    T1017 HE Targeted Case Management - Developmental Disability per week $ 61.01 7/1/2012
    T1023 Diagnostic Assessment Event $ 231.30 7/1/2012
    S9484 HA Facility-Based Crisis Program - Children and Adolescents per hour $ 30.00 7/1/2021

    H2036 Medically Monitored or ADATC Detoxification/Crisis Stabilization per diem


    An individual facility rate will be determined

    DHB Provider Reimbursement


    Date: July 1, 2021 Enhanced_Services_Fee_Schedule_2022_04_27

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