Behavioral Health Service Rate Updates Effective January 1, 2024
Download PDF
The purpose of this bulletin is to inform providers that select Behavioral Health (BH) service rates will increase effective January 1, 2024.
In accordance with the 2023 Appropriation Act[1], the Department of Medical Assistance Services (DMAS) shall increase reimbursement rates by 10% for a set of specified behavioral health services (Items 304.VVVV.1 and 304.VVVV.2); further increase rates for two of those services (Item 304.WWWW.) and begin providing reimbursement for collaborative care management (Item 304.AAAAA.) Please see a list of applicable codes and rates as well as budget item references below.
CODE | SERVICE DESCRIPTION | CODE DESCRIPTION IN FEE FILE | IP/OP | 100%[2] RATE EFFECTIVE 1/1/2024 (Physician) | TIERED RATE EFFECTIVE 1/1/2024 (Licensed Clinical Psychologist) | TIERED RATE EFFECTIVE 1/1/2024 (All Other Qualifying Licensed BH Provider Types) |
|---|---|---|---|---|---|---|
90785 | Interactive Complexity Add-on | PSYTX COMPLEX INTERACTIVE | IP | $14.95 | 90% | 67.5% |
90785 | Interactive Complexity Add-on | PSYTX COMPLEX INTERACTIVE | OP | $16.86 | 90% | 67.5% |
90791 | Psychiatric Diagnostic Evaluation | PSYCH DIAGNOSTIC EVALUATION | IP | $170.54 | 90% | 67.5% |
90791 | Psychiatric Diagnostic Evaluation | PSYCH DIAGNOSTIC EVALUATION | OP | $197.75 | 90% | 67.5% |
90792 | Psychiatric Diagnostic Evaluation with medical services | PSYCH DIAG EVAL W/MED SRVCS | IP | $194.68 | n/a | n/a |
90792 | Psychiatric Diagnostic Evaluation with medical services | PSYCH DIAG EVAL W/MED SRVCS | OP | $222.28 | n/a | n/a |
90832 | Psychotherapy with patient, 30 min | PSYTX W PT 30 MINUTES | IP | $75.12 | 90% | 67.5% |
90832 | Psychotherapy with patient, 30 min | PSYTX W PT 30 MINUTES | OP | $85.46 | 90% | 67.5% |
90833 | Psychotherapy with patient, 30 min, w/E&M services | PSYTX W PT W E/M 30 MIN | IP | $70.14 | n/a | n/a |
90833 | Psychotherapy with patient, 30 min, w/E&M services | PSYTX W PT W E/M 30 MIN | OP | $78.56 | n/a | n/a |
90834 | Psychotherapy with patient, 45 min | PSYTX W PT 45 MINUTES | IP | $99.64 | 90% | 67.5% |
90834 | Psychotherapy with patient, 45 min | PSYTX W PT 45 MINUTES | OP | $113.06 | 90% | 67.5% |
90836 | Psychotherapy with patient, 45 min, w/E&M services | PSYTX W PT W E/M 45 MIN | IP | $88.91 | n/a | n/a |
90836 | Psychotherapy with patient, 45 min, w/E&M services | PSYTX W PT W E/M 45 MIN | OP | $99.64 | n/a | n/a |
90837 | Psychotherapy with patient, 60 min | PSYTX W PT 60 MINUTES | IP | $146.40 | 90% | 67.5% |
90837 | Psychotherapy with patient, 60 min | PSYTX W PT 60 MINUTES | OP | $166.32 | 90% | 67.5% |
90838 | Psychotherapy with patient, 60 min, w/E&M services | PSYTX W PT W E/M 60 MIN | IP | $118.04 | n/a | n/a |
90838 | Psychotherapy with patient, 60 min, w/E&M services | PSYTX W PT W E/M 60 MIN | OP | $131.84 | n/a | n/a |
90839 | Psychotherapy for crisis, first 60 min | PSYTX CRISIS INITIAL 60 MIN | IP | $139.96 | 90% | 67.5% |
90839 | Psychotherapy for crisis, first 60 min | PSYTX CRISIS INITIAL 60 MIN | OP | $178.49 | 90% | 67.5% |
90840 | Psychotherapy for crisis, additional 30 min | PSYTX CRISIS EA ADDL 30 MIN | IP | $66.36 | 90% | 67.5% |
90840 | Psychotherapy for crisis, additional 30 min | PSYTX CRISIS EA ADDL 30 MIN | OP | $84.52 | 90% | 67.5% |
90845 | Psychoanalysis | PSYCHOANALYSIS | IP | $94.66 | 90% | 67.5% |
90845 | Psychoanalysis | PSYCHOANALYSIS | OP | $106.92 | 90% | 67.5% |
90846 | Family/Couples psychotherapy w/o patient present, 50 min | FAMILY PSYTX W/O PT 50 MIN | IP | $107.69 | 90% | 67.5% |
90846 | Family/Couples psychotherapy w/o patient present, 50 min | FAMILY PSYTX W/O PT 50 MIN | OP | $108.08 | 90% | 67.5% |
90847 | Family/Couples psychotherapy with patient present, 50 min | FAMILY PSYTX W/PT 50 MIN | IP | $112.29 | 90% | 67.5% |
90847 | Family/Couples psychotherapy with patient present, 50 min | FAMILY PSYTX W/PT 50 MIN | OP | $112.67 | 90% | 67.5% |
90853 | Group Psychotherapy | GROUP PSYCHOTHERAPY (OTHER THAN OF | IP | $26.44 | 90% | 67.5% |
90853 | Group Psychotherapy | GROUP PSYCHOTHERAPY (OTHER THAN OF | OP | $30.27 | 90% | 67.5% |
CODE | SERVICE DESCRIPTION | CODE DESCRIPTION IN FEE FILE | MODIFIER | IP/OP | NEW RATE EFFECTIVE 1/1/24 |
|---|---|---|---|---|---|
Applicable Collaborative Care Management (CoCM) CPT Codes | |||||
99492 | Initial Psychiatric Collaborative Care Management | 1st psyc collab care mgmt |
| IP | $95.46 |
99492 | Initial Psychiatric Collaborative Care Management | 1st psyc collab care mgmt |
| OP | $155.04 |
99493 | Subsequent Psychiatric Collaborative Care Management | Sbsq psyc collab care mgmt |
| IP | $104.17 |
99493 | Subsequent Psychiatric Collaborative Care Management | Sbsq psyc collab care mgmt |
| OP | $146.67 |
99494 | Initial or Subsequent Psychiatric Collaborative Care Management | 1st/sbsq psyc collab care |
| IP | $41.81 |
99494 | Initial or Subsequent Psychiatric Collaborative Care Management | 1st/sbsq psyc collab care |
| OP | $59.58 |
Applicable Mental Health Services | |||||
H0031 | Intensive In-Home Assessment | MENTAL HEALTH ASSESSMENT, BY NON-PH | OP | $74.25 | |
H0032 | Psychosocial Rehab Assessment | MENTAL HEALTH SERVICE PLAN DEVELOPM | U6 | OP | $29.99 |
H0032 | Therapeutic Day Treatment Assessment | MENTAL HEALTH SERVICE PLAN DEVELOPM | U7 | OP | $45.21 |
H0032 | Mental Health Skill-Building Assessment (Rural) | MENTAL HEALTH SERVICE PLAN DEVELOPM | U8 | OP | $102.72 |
H0032 | Mental Health Skill-Building Assessment (Urban) | MENTAL HEALTH SERVICE PLAN DEVELOPM | U8 | OP | $112.62 |
H0035 | Mental Health Partial Hospitalization Program (MH‐PHP) Community Based Clinic Program, ‐ per diem | MENTAL HEALTH PARTIAL HOSPITALIZATI | OP | $500.00 | |
H0035 | Mental Health Partial Hospitalization Program (MH‐PHP) Hospital Based Mental Health Program ‐ per diem | MENTAL HEALTH PARTIAL HOSPITALIZATI | OP | $500.00 | |
H0036 | Functional Family Therapy (Bachelor New Team) | COMMUNITY PSYCHIATRIC SUPPORTIVE TR | HK & HN | OP | $50.40 |
H0036 | Functional Family Therapy (Master New Team) | COMMUNITY PSYCHIATRIC SUPPORTIVE TR | HK & HO | OP | $54.66 |
H0036 | Functional Family Therapy (Bachelor Established Team) | COMMUNITY PSYCHIATRIC SUPPORTIVE TR | HN | OP | $42.21 |
H0036 | Functional Family Therapy (Master Established Team) | COMMUNITY PSYCHIATRIC SUPPORTIVE TR | HO | OP | $46.13 |
H0040 | Assertive Community Treatment (Large Team) | ASSERTIVE COMMUNITY TREATMENT PROGR | OP | $196.64 | |
H0040 | Assertive Community Treatment (Medium Team) | ASSERTIVE COMMUNITY TREATMENT PROGR | U1 | OP | $209.55 |
H0040 | Assertive Community Treatment (Small Team) | ASSERTIVE COMMUNITY TREATMENT PROGR | U2 | OP | $241.56 |
H0040 | Assertive Community Treatment (Large Team - High Fidelity) | ASSERTIVE COMMUNITY TREATMENT PROGR | U3 | OP | $235.22 |
H0040 | Assertive Community Treatment (Medium Team - High Fidelity) | ASSERTIVE COMMUNITY TREATMENT PROGR | U4 | OP | $255.72 |
H0040 | Assertive Community Treatment (Small Team - High Fidelity) | ASSERTIVE COMMUNITY TREATMENT PROGR | U5 | OP | $303.55 |
H0046 | Mental Health Skill Building, Urban | MENTAL HEALTH SERVICES, NOT OTHERWI | OP | $112.62 | |
H0046 | Mental Health Skill Building, Rural | MENTAL HEALTH SERVICES, NOT OTHERWI | OP | $102.72 | |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | HO | OP | $78.19 |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | 32 | OP | $78.19 |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | HK | OP | $78.19 |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | HT & HM | OP | $125.24 |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | HT & HO | OP | $133.66 |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | HT & HN | OP | $136.70 |
H2011 | Mobile Crisis Response | CRISIS INTERVEN SVC, 15 MIN | HT | OP | $145.12 |
H2012 | Intensive In-Home Services | BEHAV HLTH DAY TREAT, PER HR | OP | $74.25 | |
H2016 | Therapeutic Day Treatment | COMP COMM SUPP SVC | OP | $45.21 | |
H2016 | Therapeutic Day Treatment | COMP COMM SUPP SVC | UG | OP | $45.21 |
H2016 | Therapeutic Day Treatment | COMP COMM SUPP SVC | U7 | OP | $45.21 |
H2017 | Psychosocial Rehabilitation Services | PSYSOC REHAB SVC, PER | OP | $29.99 | |
H2018 | Residential Crisis Stabilization Unit (RCSU) | PSYSOC REHAB SVC, PER DIEM | OP | $847.04 | |
H2018 | Residential Crisis Stabilization Unit (RCSU) | PSYSOC REHAB SVC, PER DIEM | 32 | OP | $847.04 |
H2018 | Residential Crisis Stabilization Unit (RCSU) | PSYSOC REHAB SVC, PER DIEM | HK | OP | $847.04 |
H2033 | Multisystemic Therapy (Bachelor New Team) | MULTISYS THER/JUVENILE 15MIN | HK & HN | OP | $63.12 |
H2033 | Multisystemic Therapy (Master New Team) | MULTISYS THER/JUVENILE 15MIN | HK & HO | OP | $68.10 |
H2033 | Multisystemic Therapy (Bachelor Established Team) | MULTISYS THER/JUVENILE 15MIN | HN | OP | $56.96 |
H2033 | Multisystemic Therapy (Master Established Team) | MULTISYS THER/JUVENILE 15MIN | HO | OP | $61.83 |
S9480 | Mental Health Intensive Outpatient | INTENSIVE OUTPATIENT PSYCHIATRIC SE | OP | $250.00 | |
S9480 | Mental Health Intensive Outpatient (with occupational therapy) | INTENSIVE OUTPATIENT PSYCHIATRIC SE | GO | OP | $250.00 |
S9482 | Community Stabilization | FAMILY STABILIZATION 15 MIN | HN | OP | $44.25 |
S9482 | Community Stabilization | FAMILY STABILIZATION 15 MIN | HO | OP | $53.13 |
S9482 | Community Stabilization | FAMILY STABILIZATION 15 MIN | HT & HM | OP | $82.35 |
S9482 | Community Stabilization | FAMILY STABILIZATION 15 MIN | HT | OP | $94.41 |
S9485 | 23-Hour Crisis Stabilization | CRISIS INTERVENTION MENTAL HEALTH S | OP | $1,012.07 | |
S9485 | 23-Hour Crisis Stabilization | CRISIS INTERVENTION MENTAL HEALTH S | 32 | OP | $1,012.07 |
S9485 | 23-Hour Crisis Stabilization | CRISIS INTERVENTION MENTAL HEALTH S | HK | OP | $1,012.07 |
Peer Recovery Support Services | |||||
T1012 | Peer Support Services – Individual (Substance Use Disorder) | ALCOHOL AND/OR SUBSTANCE ABUSE SERV | OP | $14.30 | |
S9445 | Peer Support Services – Group (Substance Use Disorder) | PATIENT EDUCATION, NOT OTHERWISE CL | OP | $5.94 | |
H0024 | Peer Support Services – Individual (Mental Health) | BEHAVIORAL HEALTH PREVENTION INFORM | OP | $14.30 | |
H0025 | Peer Support Services – Group (Mental Health) | BEHAVIORAL HEALTH PREVENTION EDUCAT | OP | $5.94 | |
Budget Language Reference:
VVVV.1: “Effective January 1, 2024, the Department of Medical Assistance Services shall increase rates by 10 percent for the following Medicaid-funded community-based services: Intensive In-Home, Mental Health Skill Building, Psychosocial Rehabilitation, Therapeutic Day Treatment, Outpatient Psychotherapy, Peer Recovery Support Services -- Mental Health.”
VVVV.2: “Effective January 1, 2024, the Department of Medical Assistance Services shall increase rates by 10 percent for the following Medicaid-funded community-based services: Comprehensive Crisis Services (which include 23-hour Crisis Stabilization, Community Stabilization, Crisis Intervention, Mobile Crisis Response, and Residential Crisis Stabilization), Assertive Community Treatment, Mental Health - Intensive Outpatient, Mental Health - Partial Hospitalization, Family Functional Therapy and Multisystemic Therapy.”
WWWW: “The Department of Medical Assistance Services shall increase the rates for mental health partial hospitalization from a per diem rate of $250.62 to $500.00 and shall increase the rate for mental health intensive outpatient programs from a per diem of $159.20 to $250.00. The department shall have the authority to implement this reimbursement change effective January 1, 2024, and prior to the completion of any regulatory process undertaken in order to effect such change.”
AAAAA: “Effective January 1, 2024, the Department of Medical Assistance Services shall have the authority to amend the State Plan under Title XIX of the Social Security Act to provide reimbursement for the provision of behavioral health services that are classified by a Current Procedural Terminology code as collaborative care management services.”
These rates apply to behavioral health program services included in Items 304.VVVV.1, 304.VVVV.2, 304.WWWW, and 304.AAAAA of the 2023 Appropriation Act only. Services and rates are subject to claims payment processing procedures which may result in different reimbursement according to billing practices and program participation. All claims are subject to post payment review.
Behavioral Health Rates Effective January 1, 2024
This memo serves as the official notification that behavioral health rates effective January 1, 2024 will be posted to the DMAS website at Procedure Fee Files & CPT Codes | DMAS - Department of Medical Assistance Services (virginia.gov). If you have any questions about this memo please call the provider helpline at 800-552-8627.
Appeals Information
If you believe an error was made for payment rates or totals, you can file an appeal. The appeal must be filed with the DMAS Appeals Division through one of the following methods:
- Through the Appeals Information Management System at https://www.dmas.virginia.gov/appeals/. From there you can fill out an informal appeal request, submit documentation, and follow the process of your appeal.
- Through mail, email, or fax. You can download a Medicaid Provider Appeal Request form at https://www.dmas.virginia.gov/appeals/. You can use that form or a letter to file the informal appeal. The appeal request must identify the issues being appealed. The request can be submitted by:
- Mail or delivery to: Appeals Division, Department of Medical Assistance Services, 600 E. Broad Street, Richmond, VA 23219;
- Email to appeals@dmas.virginia.gov; or
- Fax to (804) 452-5454
The appeal must be received by the DMAS Appeals Division within 30 days of the payment rate or total being published by DMAS. The notice of appeal is considered filed when it is date stamped by the DMAS Appeals Division. The normal business hours of DMAS are from 8:00 a.m. through 5:00 p.m. on dates when DMAS is open for business. Documents received after 5:00 p.m. on the deadline date shall be untimely.
[1] Items 304.VVVV.1, 304.VVVV.2, 304.WWWW, and 304.AAAAA
PROVIDER CONTACT INFORMATION & RESOURCES | |
Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | |
Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | 1-800-884-9730 or 1-800-772-9996 |
Acentra Health Service authorization information for fee-for-service members.
| |
Provider Appeals DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal. | |
Managed Care Programs Cardinal Care Managed Care and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. | |
Cardinal Care Managed Care | https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-… |
PACE | |
Acentra Health Behavioral Health Services
| |
Provider Enrollment | In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. | 1-804-786-6273 1-800-552-8627 |
Aetna Better Health of Virginia | https://www.aetnabetterhealth.com/virginia/providers/index.html 1-800-279-1878
|
Anthem HealthKeepers Plus | 1-800-901-0020
|
Molina Complete Care
| 1-800-424-4524 https://www.molinahealthcare.com/providers/va/medicaid/home.aspx
|
Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
|
United Healthcare | 1-844-284-0149
|
Dental Provider DentaQuest | 1-888-912-3456 |