HCPCS codes are required on all adult mental health day treatment claims. Claims or adjustments for adult mental health day treatment services received without a HCPCS code are denied. Providers should refer to the maximum allowable fee schedule for maximum allowable fees and copayment rates.
Rounding guidelines are available.
Assessment services are limited to eight hours every rolling 12 months per member before PA is required under DHS 107.13(2)(c)4., Wis. Admin. Code, for the following services:
The following table lists the HCPCS code and modifier that providers are required to use when requesting PA and submitting claims for adult mental health day treatment services.
| HCPCS Code | Description | Program Modifier Code | Service Modifier Code | Allowable ICD Diagnosis Codes* | Telehealth Services Covered? | Prior Authorization Required? |
| H2012 | Behavioral health day treatment, per hour | HE Mental health program |
None | F07.0–F09 F20.0–F69 F90.0–F99
|
For individual services only | Yes, for:
|
| Behavioral health day treatment, per hour | HE Mental health program |
U6 Functional Assessment |
Diagnosis code required, no restrictions | Yes | No, but PA is required for additional assessment hours beyond eight hours every rolling 12 months. Providers may submit a PA request for additional assessment hours beyond the eight-hour limit by submitting the PA/EA with the PA request. |
| * | The list of allowable ICD diagnosis codes for adult mental health day treatment is inclusive. However, not all Medicaid-covered adult mental health day treatment services are appropriate or allowable for all diagnoses. BadgerCare Plus and Wisconsin Medicaid base approval of services on a valid diagnosis, acceptable adult mental health day treatment practice, and clear documentation of the probable effectiveness of the proposed service. |