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Therapeutic Behavioral Health (H2020)
Same Day as Another Per Diem Service or Any Psychotherapy

Thank you for your continued partnership in serving WellCare of Kentucky members. We have an important reminder to share with you: It’s related to the therapeutic behavioral health (H2020) per diem code billed for the same date of service as any other per diem code or any psychotherapy code.

Therapeutic Behavioral Per Diem (H2020) Same Day as Individual, Family, or Group Psychotherapy (90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90870, 90875, 90876, H0004), Intensive Outpatient Program/IOP (H0015), Partial Hospitalization (H0035), or any Residential Per Diem Code:

H2020 inherently encompasses at least three hours of clinical care in a day.

In accordance with DMS regulations 907 KAR 15:010, 907 KAR 15:020, and 907 KAR 15:022; and as supported by American Society of Addiction Medicine levels of care (ASAM) criteria; Interqual® outpatient behavioral health criteria; Level of Care Utilization Systems (LOCUS) criteria; Child and Adolescent Needs and Strengths of Scale (CANS) criteria; and Early Childhood Service Intensity Instrument (CASII) criteria, multiple per diem services are not appropriate or reimbursable if rendered/billed for the same date of service for a member. 

Effective March 1, 2025 WellCare will not reimburse for H2020 billed on the same day as any other per diem code or any psychotherapy code.

Please note: The above list of codes is not necessarily an all-inclusive list. If the Department for Medicaid Services recognizes, at any point, additional psychotherapy codes or per diem codes, H2020 will not be reimbursable if billed the same day as any such additional code(s).

Recovery Scenario

If you receive(d) payment for H2020 for the same date of service as any other per diem code or any psychotherapy code for the same member, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

Applicable Regulations

  • 907 KAR 15:010 coverage provisions and requirements regarding behavioral health services provided by individual behavioral health practitioners, behavioral health provider groups, and behavioral health multi-specialty groups.
  • 907 KAR 15:020 coverage provisions and requirements regarding behavioral health services organizations for mental health treatment.
  • 907 KAR 15:022 coverage provisions and requirements regarding behavioral health services organizations for substance use disorder treatment and co-occurring disorders.
  • 907 KAR 15:080, coverage provisions and requirements regarding chemical dependency treatment services.
  • 907 KAR 1:044, coverage provisions and requirements regarding community mental health center behavioral health services.

Again, we thank you for your continued partnership in delivering quality healthcare to our members. If you have any question regarding this notice, please contact your Provider Relations Representative.

Sincerely,

WellCare of Kentucky