Behavioral Health claims

Date: 04/03/17

Heritage Health (Medicaid):

The NDHHS Fee Schedule (PDF) identifies the behavioral health services that are covered by Nebraska Total Care. This includes identifying what provider types can be paid for each CPT code. If the Fee Schedule does not have a rate identified for a provider type, the service is not covered for that provider type and claims will be denied.

For example:

• CPT code 90792 has rates provided for MD (1), DO (2), PA (22), and APRN (29). These providers can be paid for the CPT code 90792. 
• There is no identified rate for CPT Code 90792 for LMHP (36), PLMHP (37), PhD CAND (38), LIMHP (39), PhD PROV (57), PLADC (58), PHD (64 S), PhD (67), and LADC (78). Claims for a 90792 by one of these providers will be denied. 

There is one identified exception. If an LIMHP bills for a 90791, this claim can be paid as a H0031 HO at the posted rate.