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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/26/2024

 

To:  Community Mental Health Providers, Behavioral Health Clinics, Licensed Clinical Psychologists, Licensed Clinical Social Workers, Licensed Clinical Professional Counselors, and Licensed Marriage and Family Therapists
​Date November 26, 2024
​Re:
 Publication of Revised Community-based Behavioral Services Fee Schedules, System Issue Resolutions and Billing Guidance

This notice informs providers delivering services pursuant to the Handbook for Providers of Community-Based Behavioral Services (CBS) of the publication of revisions to the corresponding CBS fee schedule to address claiming issues for procedure codes H2000, T1999 and H0046, and to provide associated billing guidance. The revisions for H2000, T1999 and H0046 affect all CBS fee schedules posted with effective dates on or after July 1, 2022.

For fee schedules with an effective date on or after December 1, 2022, the revised fee schedules introduce modifiers for procedure codes T1999 and H0046 to differentiate billing between services for customers enrolled in the Pathways to Success and Family Support Program (FSP) to address known systems issues. The systems issues affect any services for T1999 and H0046 with a prior authorization begin date on or after December 1, 2022, to October 31, 2024.

Summary of Revisions

For fee schedules with an effective date on or after July 1, 2022, the service of IATP: LPHA Review has been moved to Group B Services to accurately reflect providers who can submit for reimbursement.

Beginning with dates of service December 1, 2022, procedure codes T1999 and H0046 must have modifier HK when delivered to a customer enrolled in the Pathways to Success program, and modifier SE must be used when delivered to customers enrolled in the Family Support Program. If a customer is enrolled in both programs, providers are expected to use modifier HK.

Billing Guidance

Providers with claims for T1999 or H0046 that have been impacted by this system issue will be required to rebill the affected claims. All services for T1999 and H0046 must have a prior authorization reviewed and approved by the Department.

Services delivered with a date of service between December 1, 2022, and October 31, 2024, will be considered for a timely filing override. All claims for T1999 and H0046 must be submitted to HFS for reimbursement and are not reimbursable by the HealthChoice Illinois Managed Care Plans.

Providers may direct questions to a community mental health center billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, option sequence 1, 2, 4, then 8.  Providers needing only to request a timely filing override may submit their claim(s) electronically with the HFS 1624 Override Request Form as an electronic attachment.

 

Kelly Cunningham, Administrator
Division of Medical Programs