Updated Guidelines for Billing HCPCS Codes H0031 & H0032

Can You Bill H0031 and H0032 on Separate Days? Updated Billing Guidelines for Mental Health Providers

Understanding HCPCS Codes H0031 & H0032

HCPCS code H0031 is designated for mental health assessments conducted by non-physician providers. This encompasses comprehensive evaluations to determine an individual’s mental health needs, including diagnostic evaluations and screenings.

HCPCS code H0032 pertains to the development of mental health service plans by authorized non-physician providers. This involves creating or modifying treatment plans based on assessments and clinical judgments.

Both codes are integral in the continuum of mental health care, ensuring that patients receive appropriate assessments and individualized treatment plans.

Billing Guidelines for H0031 & H0032

When billing for H0031 and H0032, providers must adhere to specific guidelines to ensure compliance and proper reimbursement:

• Frequency Limits: Typically, these codes can be billed up to four times per calendar year per patient. However, this may vary based on payer policies.
• Documentation: Detailed documentation is essential. For H0031, this includes the assessment findings, methodologies used, and conclusions. For H0032, the treatment plan developed, goals set, and interventions planned should be documented.
• Provider Qualifications: Only qualified non-physician providers, such as Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), and other recognized mental health professionals, are authorized to bill these codes.
• Time-Based Billing: H0031 is typically billed per hour, while H0032 may be billed in 15-minute increments, depending on payer specifications.

Scenario: Splitting Services Over Multiple Days

Question: A patient underwent a Mental Health Assessment (MHA) and plan development by a Qualified Mental Health Professional (QMHP) on two separate days due to the provider’s scheduling constraints. The provider documented each session as “part 1” and “part 2,” spending an hour on services each day. They intend to bill H0031 and H0032 for each day. Is this appropriate?

Answer: Billing H0031 and H0032 on separate days for parts of a single assessment and treatment plan, divided due to provider scheduling constraints, is generally not recommended. The Centers for Medicare & Medicaid Services (CMS) and other payers expect that assessments and treatment plans are comprehensive and, when possible, conducted in a single session. Splitting these services without a clinical justification may be viewed as circumventing billing guidelines.

Furthermore, billing these codes multiple times for the same assessment and plan could exhaust the annual allowable limits, potentially hindering future necessary services for the patient within the same year.

If circumstances necessitate splitting services over multiple days, it’s crucial to:

• Clearly document the clinical reasons for the division (e.g., patient fatigue, complexity of assessment).
• Ensure that each session is complete in its own right, with distinct objectives and outcomes.
• Consult with the specific payer to confirm their policies on billing split services.

Always prioritize ethical billing practices and ensure that services billed reflect the care provided.

References

• CMS Psychiatry and Psychology Services Billing Guidelines
• CMS 1500 Claim Billing: CPT Code H0031
• Coding.Health: How to Bill HCPCS Code H0031
• Coding.Health: How to Bill HCPCS Code H0032

Disclaimer: This article is for informational purposes only and does not constitute legal or medical advice. Providers should consult with payers and official guidelines to ensure compliance.

http://www.cms1500claimbilling.com/2016/08/cpt-code-h0031.html