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PCPA Working on Corrections/Clarifications on New Medical Assistance Rates
July 2, 1999

PCPA has determined that there are several problems with the new Medical Assistance rates. We are in the process of getting things corrected/clarified by the Office of Medical Assistance (OMAP).

The issues are as follows:

1. Under outpatient rates for D&A and Mental Health there was a problem with the codes for the quarter hour increments. The code for the quarter hour increments under D&A was omitted and the quarter hour code for Mental Health was only $10.00 and should have been $13.00. We are confident that OMAP will work to correct these problems. If you are seeing a client for a full 60 minutes, bill the first half hour of mental health outpatient psychotherapy using the code W9801 and for each subsequent 15 minute increment use code W0148. Providers should bill D&A services using W9801 for the first half-hour and W0149 for the quarter hour increments.

OMAP prefers the provider to bill for individual psychotherapy using the quarter hour increments after the first half-hour. However, it is possible to bill for two half-hour units, but it is critical that the provider can document the full 60 minutes of psychotherapy.

2. The code W0864 (which we understand is infrequently used) for adult partial hospitalization services provided in a children's psychiatric partial hospitalization program was inadvertently omitted and will be included in a new bulletin which will be released by OMAP in the near future.

If you have any questions please contact Lynn Cooper.

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