NC Medicaid BH:  info for H0038

Are you a BH provider that accepts NC Medicaid plan types, then this blog post is for you!

Basic information about the code:

  • H0038-peer/self help services performed by a trained professional- mental health/SUD
  • 1 unit= 15 min
  • This code can be used for one-on-one recovery support, group facilitation, skill-building, resource navigation, and community integration.
  • Can be performed by credentialed or certified peer support specialist
  • May have max number of units per year- depends on the payer

Prior authorization:

  • The documents that need to be submitted for the prior auth- Active service order, current clinical assessment, personal centered plan
  • Person centered plan should include: detailed progress towards goals, currwnt clinical information, any referrals for other specialists, and discharge info.
  • Max # of units per NC Medicaid Fiscal Year– 24 units after – no auth required
  • Auth required any number of units beyond 24

Billing:

  • 1 unit equals 15 min increments
  • Group peer services should be billed with modifier HQ- not allowed to be performed via telehealth
  • Time needs to be documented – best practice to document the start and end time
  • Phone only services should use modifier KX
  • Services done via telehealth should be billed with modifier GT

Best practices not to lose revenue:

  • If your office is not sure if the member met their 24 unit for the year- please submit the prior auth request
  • Make sure to bill the proper amount of units
  • Make sure to bill the proper modifiers
  • Document start and end times

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