2021-25: Reminder - Provider Information on Evidence Based Practice Tracking (revised 5.13.22)
Date: 07/22/21
Since 2019, the Louisiana Department of Health (LDH) has been tracking utilization of behavioral Health therapeutic Evidence-Based Practices (EBP) on Louisiana Healthcare Connections submitted encounter records.
The Medicaid Specialized Behavioral Health fee schedule currently includes CPT/HCPCS codes for only four EBP programs (Functional Family Therapy (FFT), Multisystemic Therapy (MST), Homebuilders, and Assertive Community Treatment (ACT)). LDH’s goal is to be able to track the provision and utilization of other EBP behavioral health programs, which currently cannot be tracked via claim record CPT/HCPCS codes.
LDH is asking providers to communicate utilization of EBP programs by including an EBP tracking code in the note field of the claim record sent to Louisiana Healthcare Connections. Louisiana Healthcare Connections shall accept EBP tracking codes on claim records in either the CMS 1500’s FL 19 field or in the 837’s Loop 2400 SV101-7 data element or in the note field on the provider portal for claim submissions.
When billing an EBP related service on a paper CMS 1500 claim, please use the format below in Box 19:
X1 – Represents the service line this EBP code is referenced to
EB01 – Represents the EBP code required for the service billed on the service line specified above.
There can only be 1 EBP code billed per service line.
If the same EBP code is required for multiple service lines, that EBP code must be billed specifically for each service line, like shown below:
Louisiana Healthcare Connections is responsible for verifying that providers are properly credentialed to deliver the additional EBP programs.
The following table contains the current list of EBP tracking codes, associated CPT/HCPCS codes, as well as guidance on appropriate documentation of provider qualifications that should be linked to use of EBP tracking codes via credentialing. Additional EBPs with associated tracking codes will be added over time. The MMIS adjudication system will be setup with edits to deny Louisiana Healthcare Connections encounter records when an EBP tracking code is used with a mismatched CPT/HCPCS code.
Providers can submit documentation to the Louisiana Healthcare Connections credentialing email box: LHC_Provider_Credent@centene.com.
| EVIDENCE-BASED | EBP TRACKING | VALID CPT/HCPCS | CREDENTIALING DOCUMENTATION TO PROVIDE TO MCO |
|---|---|---|---|
| Functional Family Therapy-Child Welfare (FFT-CW) | EB01 | H0036 with modifier HE | Agency FFT License with FFT-CW specialty from FFT, LLC. |
| Child-Patient Psychotherapy (CPP) | EB02 | 90832, 90834, 90837, 90846, 90847 | Certificate stating that the clinician has fulfilled the requirements of an implementation level of Child-Parent Psychotherapy, from a trainer endorsed by the University of California, San Fransciso. |
| Parent-Child Interaction Therapy (PCIT) | EB03 | 90832, 90834, 90837, 90846, 90847 | Certification from PCIT, International. |
| Youth PTSD Treatment (YPT) | EB04 | 90832, 90834, 90837, 90846, 90847 | Advanced Certification from Tulane Psychiatric in Youth PTSD Treatment |
| Preschool PTSD Treatment (PPT) | EB05 | 90832, 90834, 90837, 90846, 90847 | Advanced Certification from Tulane Psychiatric in Preschool PTSD Treatment |
| Triple P Level 4 | EB06 | 90837, 90834, 90832, 90847, 90846 | Triple P Positive Parenting Program: accreditation by Triple P America (TPA) |
| TF-CBT | EB07 | 90837, 90834, 90832, 90847, 90846 | Documentation of certification through the Trauma-Focused Cognitive Behavioral Therapy Program (TF-CBT). Certified TF-CBT therapist are listed on a national registry at http://tfcbt.org/members/ |
| EMDR Therapy - Eye Movement Desensitization and Reprocessing | EB08 | 90837, 90834, 90832, 90839 | Documentation of completion of EMDRIA Approved Basic Training. A directory of practitioners who have completed EMDIRA Approved Basic Training can be found at www.emdria.org. |