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Behavioral Health Services Organization (BHSO) Tier II Narcotic Treatment Program (NTP) and Community Mental Health Center NTP Billing/Coding Changes

11/12/2020

Dear Provider and Staff,

WellCare of Kentucky has some important information to share with you pursuant to billing and coding guidance issued by the Department for Medicaid Services (DMS) related to BHSO Tier II NTPs and CMHC NTPs.  

H0020 and H0047 Limit

Effective July 1, 2020, BHSO Tier II NTPs and CMHC NTPs became eligible to be reimbursed for H0020, Methadone Medication Assisted Treatment (MAT) bundle, weekly, only billable by an NTP and H0047, Buprenorphine MAT bundle, weekly, only billable by an NTP. Previously, BHSO Tier II NTPs and CMHC NTPs were only paid for H0020.

Please note, both codes represent a weekly, all-inclusive (bundled) set of services/ procedures as established by the DMS behavioral health and substance use services fee schedule. The limit for each is one unit per member, per week.

WellCare will deny any claims with either of the above codes with a unit exceeding one per week, per member. Additionally, if you were erroneously paid for more than one unit of H0020 or H0047 per week, per member, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

H0020 and H0047 Bundle Scope

As noted above, H0020 and H0047 represent an all-inclusive (bundled) array of substance use disorder (SUD) codes. Each code encompasses other services/codes that may not be billed for the same time period for the member. Other services/codes that may not be billed concurrently include medication administration or dosing; presumptive drug screening (80305, 80306, 80307); interactive complexity (90785); psychotherapy (90832, 90833, 90834, 90836, 90837, and 90838); crisis (90839 and 90840); group psychotherapy (90853); psychotherapy add-on codes (99354 and 99355); drug and alcohol assessment (H0001); and alcohol and/or other drug services (H0015).

WellCare will apply the DMS-issued billing rules and limits and will deny any claim that does not comply with the rules. Additionally, if you were erroneously paid for a claim that contradicted any of the above rules, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

H0033 Replaced by H0016/Limit

Effective July 1, 2020, DMS replaced code H0033 (Methadone induction) with code H0016 (Buprenorphine or Methadone induction). H0016, per DMS guidance, applies to both Buprenorphine induction as well as Methadone induction.

The limit – four events per year, per member – remained the same.

WellCare will deny any claims for H0033 with a date of service after June 30, 2020 and will deny any claims for H0016 exceeding the limit.

Additionally, if you were erroneously paid for any claim with code H0033 and a date of service after June 30, 2020 or for any claim with H0016 exceeding the limit, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

If you have any question regarding this notice, please contact your Provider Relations representative.

Sincerely,

WellCare of Kentucky