The following information of interest to PCPA members has been added to the "What’s New?" section of the Department of Public Welfare (DPW) Office of Medical Assistance Programs web site (www.dpw.state.pa.us/omap/news/omapnews.asp)Medical Assistance (MA) Bulletin
MA Bulletin #02-05-01, Preferred Drug List - Phase 1 (www.dpw.state.pa.us/omap/provinf/mabull/020501.asp)Remittance Advice Alerts/PROMISe™ Banner Page
- 2005 HCPCS and National Codes (www.dpw.state.pa.us/omap/provinf/RA092605a.asp)
- Recovery of Inpatient Duplicate Claims (www.dpw.state.pa.us/omap/provinf/RA092605b.asp)
- MA 314 (www.dpw.state.pa.us/omap/provinf/RA092605c.asp)
- ACCESS Card Verification (www.dpw.state.pa.us/omap/provinf/RA092605d.asp)
Other
- PROMISe™ Pharmacy Provider Issues Log (www.dpw.state.pa.us/Resources/Documents/Pdf/PROMISe/Pharmacy%20Provider%20Issues.pdf)
- PA PROMISe™ Quick Tip #15 Concerning Copayments for Prescription Drugs (www.dpw.state.pa.us/omap/promise/PDF/PROMISeQuickTip15.pdf)
- Pennsylvania Medicaid MCO Directory for October (www.dpw.state.pa.us/omap/hcmc/omapmcodir.pdf)
- Managed Care Statistical Report for September (www.dpw.state.pa.us/omap/hcmc/mcstatreportSept05.pdf)
The Office of Mental Health and Substance Abuse Services has also provided PCPA with the table below regarding national codes for crisis intervention services. DPW added three pricing modifiers to three separate codes in order to permit claims to process properly. National codes are to be used for dates of service beginning October 1. Follow the link to the OMHSAS Bulletin, Mental Health Crisis Intervention (MHCI) Fee Schedule, referenced in the table (www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=2015). Questions regarding the codes may be addressed to the Behavioral Health Hotline (800-433-4459).
| Local
Code |
Local
Code Description |
National
Code |
ProviderType |
PROMISe
Specialty |
POS |
Pricing
Modifier |
Info
Modifier |
National
code Definition |
MA
Unit of Service |
Comments |
| W9792 |
Telephone
Crisis |
H0030 |
11 |
118 |
11 |
None
|
None
|
Behavioral
Health Hotline Service |
15
min |
Please
refer to rates published in OMHSAS-01-03. |
| W9793 |
Walk-in
Crisis |
H2011 |
11 |
118 |
11 |
None
|
None
|
Crisis
Intervention Service, per 15 min |
15
min |
Please
refer to rates published in OMHSAS-01-03. |
| W9794 |
Mobile
Crisis, Individual Delivered |
H2011 |
11 |
118 |
15 |
UB |
HE |
Crisis
Intervention Service, per 15 min |
15
min |
Please
refer to rates published in OMHSAS-01-03. |
| W9795 |
Mobile
Crisis, Team Delivered |
H2011 |
11 |
118 |
15 |
U7 |
HT |
Crisis
Intervention Service, per 15 min |
15
min |
Please
refer to rates published in OMHSAS-01-03. |
| W9796 |
Crisis
In-Home Support |
S9484 |
11 |
118 |
12,
99 |
None
|
None
|
Crisis
Intervention mental health services, per hour |
per
hour |
MIN
4 units Please refer to rates published in OMHSAS-01-03. |
| W9797 |
Medical
Mobile Crisis, Team Delivered |
H2011 |
11 |
118 |
15 |
U9 |
HK |
Crisis
Intervention Service, per 15 min |
15
min |
Please
refer to rates published in OMHSAS-01-03. |
| W9798 |
Crisis
Residential |
S9485 |
11 |
118 |
12 |
None
None
|
None
|
Crisis
Intervention mental health services, per diem |
per
diem |
Each
per diem is 8 hours and 1 unit would be a minimum of 4 hours and a maximum
of 8 hours. MIN 1 MAX 3 per day. Please refer to rates published in OMHSAS-01-03. |