RCPA - Rehabilitation and Community Providers Association


DPW Implements National Codes
October 2, 2005

The Department of Public Welfare (DPW) will implement national codes for behavioral health services beginning October 1. Medical Assistance Program Fee Schedule Procedure Code Changes for Behavioral Health Services, a new bulletin from the Office of Medical Assistance Programs, was issued September 8. The bulletin is accessible at www.dpw.state.pa.us/omap/provinf/mabull/080505.asp. A crosswalk between local and national codes is attached to the bulletin. This is the official reference for the codes, but the Office of Mental Health and Substance Abuse Services (OMHSAS) has created a color coded spreadsheet that may offer members a handy, informal reference. OMHSAS highlighted various service areas in color so they are easily identified and added the national CPT codes that some service areas have available to them. This reference chart is available from the link at the bottom of this page.

DPW conducted teleconference training on these codes in September. On October 18, DPW is again offering Conference Call Training on the Implementation of National Codes for Behavioral Health-Related Providers. For further information and to register, please refer to the PA PROMISe™ Provider Conference Call Training page of the DPW web site (www.dpw.state.pa.us/omap/promise/provconfcalltrng_process.asp). Participation is limited to the first 100 registrants.

OMHSAS has responded as follows to several questions that were raised by PCPA:

  • There was some confusion about the true implementation date for the national codes used for behavioral health services. The codes are to be implemented October 1.
  • There have been several questions related to possible changes in co-payments as a result of the changes in units of service, e.g. from 30 minutes with an extension to multiple 15-minute units. The issue of co-payment changes resulting from changes in unit of service duration was referred within DPW for a policy clarification.
  • There is some confusion about the different time frames for units of service in general. Specific questions have arisen regarding therapeutic staff support (TSS) and Mobile Therapy; can they be billed in 15 minute increments or must they be billed in 30 minutes with two units of service? Both be billed in two-unit increments. Medical Assistance policy does not allow this in 15 minute increments. Although coding for this service may impact how units are billed, no policy changes occurred with these services; therefore the service delivery and overall reimbursement will not change.
  • Some codes seem to be missing, e.g., a code for TSS Aide (formerly W0613). TSS Aide is a program exception service. When providers request services that are program exceptions, the procedure code will be listed on their program exception notice. When authorizations are returned to providers, it is imperative that providers pay close attention to the authorization and bill accordingly.

Please contact Betty Simmonds at PCPA with feedback on implementation of the national codes.

OMHSAS CrosswalkOMHSAS National CPT Codes Crosswalk

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