The following tables list the HCPCS procedure codes and applicable modifiers that providers are required to use when submitting claims for mental health and substance abuse screening, preventive mental health counseling, and substance abuse intervention services for pregnant women enrolled in BadgerCare Plus or Wisconsin Medicaid. Not all providers may be reimbursed for a particular service.
|
Place of Service Codes |
|
| 03 | School |
| 11 | Office |
| 12 | Home |
| 21* | Inpatient Hospital |
| 22 | Outpatient Hospital |
| 23 | Emergency Room / Hospital |
| 99 | Other Place of Service |
|
Mental Health and Substance Abuse Screening and Preventive Counseling/Intervention Services for Pregnant Women |
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Procedure Code |
Description |
Required Modifier |
Limitations |
Allowable ICD-9-CM Diagnosis |
Allowable Place of Service |
| H0002 Mental Health and Substance Abuse Screening |
Behavioral health screening to determine eligibility for admission to
treatment program (Unit equals one, regardless of time) |
HE (Mental health program) or HF (Substance abuse program) |
Limited to one unit per member per pregnancy. | V28.9 (Unspecified antenatal screening) |
03, 11, 12, 21*, 22, 23, 99 |
| H0004 Preventive Mental Health Counseling and Substance Abuse Intervention |
Behavioral health counseling and therapy, per 15 minutes
(Unit equals 15 minutes) |
Required HE (Mental health program) HF (Substance abuse program) |
Limited to 16 units per member per pregnancy.
Only four units of service are allowed per date of service (DOS). A screening (H0002 with modifier "HE" or "HF") must be administered on or before the DOS for this procedure. |
V65.4 (Other counseling, not otherwise specified) |
03, 11, 12, 21*, 22, 23, 99 |
| * | Place of service code "21" is not allowed for substance abuse counselors and Master's-level mental health providers. |