Procedure Code Changes to the SBMP Fee Schedule (IB 26-01)
Date: 01/12/26
Louisiana Healthcare Connections is sharing an update to Procedure Code to the SBMP Fee Schedule (IB 26-01).
Attention Local Educational Agency (LEA) Providers: Effective February 2, 2026, the following changes will be made to the School-Based Medicaid Program (SBMP) and reflected on the EPSDT Health Services – Provider Type 70 fee schedule.
If any of the procedure codes below are submitted without a required modifier, the procedure code will be denied.
| Procedure Code | Required Modifiers (defined below) |
|---|---|
| 90846 (family psychotherapy w/o patient present) | AF, AH, AJ, HF or HO |
| 90847 (family psychotherapy w/ patient present) | AF, AH, AJ, HF or HO |
| 90853 (group psychotherapy) | AF, AH, AJ, HF or HO |
| H0004 (behavioral health counseling and treatment, per 15 minutes) | AH, AJ or HO |
| H0005 (alcohol and/or drug services; group) | AH, AJ or HO |
Modifier Descriptions
| Modifier | Description |
|---|---|
| AF | Psychiatrist (specialty physician) |
| AH | Clinical Psychologist |
| AJ | Clinical Social Worker |
| HF | Licensed Additction Counselor (substance abuse program) |
| HO | Licensed Professional Counselor (LPC) Licensed Marriage and Family Therapist (LMFT) (master’s degree program) |
Change in Coverage
| Procedure Code | Change |
|---|---|
| 97032 (Electrical stimulation) | Procedure code will deny when submitted by PT 70 |
General questions related to the changes above should be directed to Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040.