Behavioral Health Screening Tools Clarification

 

The South Carolina Department of Health and Human Services (SCDHHS) expanded the availability of behavioral health pediatric screening tools in a Medicaid Bulletin, dated May 17, 2013.

Due to changes implemented under the National Correct Coding Initiative (NCCI), edits are not allowing reimbursement for Current Procedural Terminology (CPT) code 99420 if billed in conjunction with vaccine CPT codes (90460/90461). The CPT code 96110 is being denied if billed with Evaluation and Management (E & M) CPT codes (99201-99205 and 99211-99215). Also, the CPT code 96110 is being denied if billed multiple times on the same date of service.

To correct these problems, please use the following modifiers appropriate for each scenario:

  • When billing a CPT code 99420 with vaccine codes during an EPSDT visit, use modifier 25

  • When billing a CPT code 96110 with a sick visit, use modifier 59

  • When billing a CPT code 96110 with 2 to 5 units per date of service, use modifier 59

This bulletin applies to FFS, Medical Home Networks (MHNs) and Managed Care Organizations (MCOs). If you have any questions regarding this bulletin, please contact the Provider Service Center at (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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