NOTICES
DEPARTMENT OF PUBLIC WELFARE
Medical Assistance Program Fee Schedule; Mobile Mental Health Treatment
[36 Pa.B. 6601]
[Saturday, October 28, 2006]This notice announces that the Department of Public Welfare (Department) will add Mobile Mental Health Treatment (MMHT) for Medical Assistance (MA) recipients 21 years of age and older to the MA Program Fee Schedule effective November 1, 2006.
Description of Service
MMHT is an array of services for individuals with a mental illness who have encountered barriers to, or have been unsuccessful in, receiving services in an outpatient clinic. The purpose of MMHT is to provide therapeutic treatment to minimize the need for more intensive levels of service, including crisis intervention or inpatient hospitalization. MMHT encompasses evaluation and treatment, including individual, group, and family therapy as well as medication visits in an individual's residence or other approved community site.
MMHT can be provided by any licensed mental health outpatient clinic enrolled in the MA Program. The payment rates for MMHT will be the same as the payment rates for the parallel mental health outpatient clinic services.
The procedure codes and accompanying modifiers that comprise MMHT, as well as the payment rate and limit for each procedure code, are as follows:
National
Code
Pricing
Modifier
Information
Modifier
MA
fee
Description
Unit of
Service
Limits 90801 UB HB 75.00 Psychiatric diagnostic interview examination occurrence 2 per year 90802 UB HB 75.00 Interactive psychiatric diagnostic interview examination occurrence 90804 UB HB 26.00 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, face to face 30 min * 90806 UB HB 39.00 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, face to face 45 min * 90808 UB HB 65.00 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, face to face 75 min * 90810 HB 26.00 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of nonverbal communication, in an office or outpatient facility, face to face 30 min * 90812 HB 39.00 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of nonverbal communication, in an office or outpatient facility, face to face 45 min * 90814 HB 65.00 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of nonverbal communication, in an office or outpatient facility, face to face 75 min * 90846 UB HB 13.00 Family psychotherapy (without patient present) 15 min Minimum 2 units * 90847 UB HB 13.00 Family psychotherapy (conjoint psychotherapy) with patient present 15 min Minimum 2 units * 90853 UB HB 3.50 Group Psychotherapy (other than for a multiple-family group) 15 min Minimum 1 hr * 96100 UB HB 31.00 Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, such as, WAIS-R, Rorschach, MMP) with interpretation and report (per hour) (individual, not group) occurrence One compre-
hensive diagnostic psychological evaluation or no more than $80 worth of individual psychological or intellectual evaluations per 365 days96100 TF HB 40.00 Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, such as, WAIS-R, Rorschach, MMP) with interpretation and report (per hour) (thermatic) occurrence 96100 HB 20.00 Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, such as, WAIS-R, Rorschach, MMP) with interpretation and report (per hour) (pen and paper) occurrence 96100 UB HB 31.00 Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, such as, WAIS-R, Rorschach, MMP) with interpretation and report (per hour) (pen and paper) occurrence 96100 TG HB 80.00 Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, such as, WAIS-R, Rorschach, MMP) with interpretation and report (per hour) occurrence 96117 HB 40.00 Neuropsychological testing battery (such as, Halstead-Reitan, Luria, WAIS-R) w/ interpretation and report, per hour occurrence H0034 HK & HB 20.00 Medication training and support 15 min 5 per calendar month ** 90862 UB HB 15.00 Pharmacologic management, including prescription, use and review of medication with no more than minimal medical psychotherapy 15 min 3 per 30 days ** H0034 HB 20.00 Medication training and support 15 min 4 per calendar month H2010 HK and HB 30.00 Comprehensive Medication Services, per 15 minutes 15 min 1 per week and only for clients with any one of the following diagnosis codes: 295.1X, 295.2X, 295.3X, 295.6X and 295.9X
(X = any numeric value) Diagnosis must be valid and payable per PROMISeNOTE: The place of service for each procedure code is 15.
*5 hours or 10 one-half hour sessions combined of individual, group or family psychotherapy per 30 days
** 90862/UB and H0034/HK and HB limited to any combination of 5 per calendar monthFiscal Impact
For Fiscal Year 2006-2007, the projected fiscal impact is $0.292 million in total funds ($ 0.133 million in State funds).
Public Comment
The Department received and considered input from a wide variety of stakeholders, including the Medical Assistance Advisory Committee and the Advisory Committee for the Office of Mental Health and Substance Abuse Services, in developing MMHT. Interested persons may submit written comments regarding this notice to the Department of Public Welfare, Office of Mental Health and Substance Abuse Services, Bureau of Policy and Program Development, Attention: Division Chief, P. O. Box 2675, Beechmont Building, 2d Floor, Harrisburg, PA 17105. Comments received within 30 days of publication of this notice will be considered in any subsequent revisions to the service requirements or fee schedule.
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-490. (1) General Fund;
MA-Outpatient MA-Capitation (2) Implementing Year 2006-07 is $16,000 $117,000 (3) 1st Succeeding Year 2007-08 is $31,000 $177,000 2nd Succeeding Year 2008-09 is $31,000 $177,000 3rd Succeeding Year 2009-10 is $31,000 $177,000 4th Succeeding Year 2010-11 is $31,000 $177,000 5th Succeeding Year 2011-12 is $31,000 $177,000
MA-Outpatient MA-Capitation (4) 2005-06 Program-- $945,950,000 $2,500,992,000 2004-05 Program-- $842,991,000 $2,312,457,000 2004-04 Program-- $677,979,000 $2,222,278,000 (7) Medical Assistance-Outpatient (MA-Outpatient); Medical Assistance-Capitation (MA-Capitation); (8) recommends adoption. Funds have been included to cover these increased costs.
[Pa.B. Doc. No. 06-2125. Filed for public inspection October 27, 2006, 9:00 a.m.]
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