|Program Name: ||BadgerCare Plus and Medicaid ||Handbook Area: ||Outpatient Mental Health and Substance Abuse Services in the Home or Community for Adults |
Covered and Noncovered Services : Codes
The following tables list the applicable modifiers that providers are required to use when submitting claims for outpatient mental health and substance abuse services in the home or community for adults.
| Professional Level Modifiers
||Wisconsin DSPS-certified substance abuse counselors who lack the credentials needed to be a Master's-level psychotherapist
||Master's-level psychotherapist, which includes the following:
- Certified psychotherapist with substance abuse certification
- Certified psychotherapist
- Licensed psychotherapist
Master's-level psychotherapists are licensed or certified social workers, professional counselors, or marriage/family therapists who have completed their 3,000 post-graduate supervised clinical hours per DSPS, or who have a DQA Provider Status Approval letter. This includes RNs who have a Master's degree in psychiatric mental health nursing or community nursing who have a DQA Provider Status Approval letter.
QTTs with a graduate degree are required to either have a doctoral degree from an accredited institution and be working toward full DSPS licensure as a licensed psychologist or be certified by DSPS as one of the following:|
- Marriage and family therapist in training
- Professional counselor in training
- Advanced practice social worker or certified independent social worker
||Psychiatrist billing mental health and substance abuse services
Physician billing substance abuse services
APNPs with a psychiatric specialty may only be reimbursed for a limited number of procedure codes. For reimbursement of psychotherapy procedure codes, APNPs with a psychiatric specialty must have 3,000 hours of supervised clinical experience, which has been verified by issuance of an individual Provider Status Approval letter by the DHS DQA.
APNPs with a psychiatric specialty and psychiatrists are the only mental health providers who can submit claims for psychotherapy services that include a medical E&M component. Additionally, APNPs with a psychiatric specialty are required to be separately enrolled in Wisconsin Medicaid as a nurse practitioner in order to be reimbursed for an E&M service.
Physician assistant with a psychiatric specialty who works under a licensed psychiatrist and possesses a current license to practice in Wisconsin.
||Services rendered by an individual during a practicum are reimbursable under the conditions specified in Wis. Admin. Code § DHS 107.01(2), which include, but are not limited to, the following:
- The student does not bill and is not reimbursed directly for their services.
- The student provides services under the direct, immediate, on-premises supervision of a Medicaid-enrolled provider.
- The supervisor documents in writing all services provided by the student.
||Outpatient mental health and substance abuse services provided in the home or community.