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Mental Health Rehabilitation Redesign Modifier Billing Guidelines

Date: 07/05/23

Mental Health Rehabilitation (MHR) Redesign affects behavioral health servicing providers who provide Community Psychiatric Supportive Treatment (CPST) and Psychosocial Rehabilitation (PSR) which are home and community-based services.

Louisiana Healthcare Connections adheres to the MHR Redesign Fee Schedule for rate setting and billing guidelines, which is listed on the State’s Website - SBH_FS.pdf (lamedicaid.com). Louisiana Healthcare Connection is sharing the additional guidance below surrounding Mental Health Rehabilitation (MHR) redesign modifier billing requirements with our participating providers.

Louisiana Healthcare Connections does not require age modifiers. Our system configuration and reimbursement are based on member age at the time of service. Should age modifiers be billed on MHR redesign procedure codes 96156, H0036, H2017, the claim reimbursement will be driven from the member’s age not the age modifier billed. Our system will not deny based on age modifiers.  

Required, optional and rohibited modifiers that would prompt appropriate processing per fee schedule or claim denials for each procedure code are as follows:

  • Procedure 96156: Health Behavior Assessment or Re-assessment, CPST
    • Required Modifiers
      • CPST Office – Modifier TG – Complex High-Tech Level of Care
      • CPST Community – Modifier TG – Complex High-Tech Level of Care & Modifier U8 – Services provided in natural
    • Optional: (multiple modifiers accepted)
      • Modifier U8 – Services provided in Natural Environment
      • Modifier HO - Master’s degree
      • Modifier HA – Child/Adolescent Program
      • Modifier HB – Adult Program
      • Modifier 95 – Telemedicine
      • Modifier HE – Mental Health Program
    • Prohibited:
      • n/a
  • Procedure H0036: Community Psychiatric Supportive Treatment
    • Location billed on the claim needs to align with the modifier billed to successfully process:
  • Required Modifiers:
    • Individual Office – No Modifier requirements
      • Individual Community – Modifier U8 – Services provided in Natural Environment
      • PSH Individual Office – Modifier TG – Complex High-Tech Level of Care
      • PSH Individual Community– Modifier TG – Complex High-Tech Level of Care & Modifier U8 – Services provided in Natural
    • Optional: (Multiple modifiers accepted)
      • Modifier TG – Complex High-Tech Level of Care
      • Modifier U8 – Services provided in Natural Environment
      • Modifier HO - Master’s degree
      • Modifier HA – Child/Adolescent Program
      • Modifier HB – Adult Program
      • Modifier 95 – Telemedicine
      • Modifier HE – Mental Health Program
    • Prohibited:
      • If billed modifier does not align with the appropriate location, claims will deny.
  • Procedure H2017: Psychosocial Rehabilitation
    • Location billed on the claim needs to align with the modifier billed to successfully process.
  • Required Modifiers:
    • Individual Office – 1 of following Modifiers are required:
      • Modifier HO - Master’s degree
      • Modifier HN - Bachelor’s Degree
      • Modifier HM - Grandfathered HS Diploma
    • Individual Community – Modifier U8 – Services provided in Natural Environment & 1 of following Modifiers are required:
      • Modifier HO - Master’s degree
      • Modifier HN - Bachelor’s Degree
      • Modifier HM - Grandfathered HS Diploma
    • PSH Individual Office – Modifier HQ – Group Setting
    • Group Office – Modifier HQ – Group Setting
    • Group Community– Modifier HQ – Group Setting & Modifier U8 – Services provided in Natural
    • PSH Group Office – Modifier HQ – Group Setting & Modifier TG – Complex High-Tech Level of Care
    • PSH Group Community– Modifier HQ – Group Setting, Modifier U8 – Services provided in Natural & Modifier TG – Complex High-Tech Level of Care
    • PSH Individual Community– Modifier HQ – Group Setting & Modifier U8 – Services provided in natural
  • Optional: (multiple modifiers accepted)
    • Modifier TG – Complex High-Tech Level of Care
    • Modifier U8 – Services provided in Natural Environment
    • Modifier HO - Master’s degree
    • Modifier HN - Bachelor’s Degree
    • Modifier HM - Grandfathered HS Diploma
    • Modifier HQ – Group Setting
    • Modifier HA – Child/Adolescent Program
    • Modifier HB – Adult Program
    • Modifier HE – Mental Health Program
  • Prohibited:
    • If billed and a modifier does not align with the appropriate location, claims will deny.

If providers have questions, please contact your Provider Engagement Administrator or Provider Services at 1-866-595-8166.