Behavioral Health Multi-Specialty Group - PT (66)

Behavioral Health Multi-Specialty Group - PT (66)

​​ Kentucky Medicaid identifies Behavioral Health Multi-Specialty Group (BHMSG) services as Provider Type (66). To enroll or bill Kentucky Medicaid, BHMSG service providers must be:

  • Licensed in the state in which they operate. In Kentucky, BHMSG service providers must contact the Office of Inspector General (OIG).
  • Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary it serves.

Covered Services

What are BHMSG services?

Medically necessary services furnished by Behavioral Health specialists through face-to-face interaction with the beneficiary with a mental and/or substance abuse disorder may include but are not limited to: assessment; service planning; individual outpatient therapy; group outpatient therapy; collateral outpatient therapy; or crisis intervention services; family outpatient therapy.

Telehealth is billable for this provider type.

How do I verify eligibility?

You may verify eligibility by:

  • contacting the automated voice response system at (800) 807-1301
  • using the Web-based KYHealth-Net System

A BHMSG must meet the coverage provisions and requirements of 907 KAR 15:010 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.

Additional Limits and Noncovered Services

The following services or activities are not ​​covered

  • a service provided to a resident of a nursing facility; intermediate care facility for individuals with an intellectual disability; inmates of a federal, local​ or state jail, detention center; or prison; or an individual with intellectual disability without documentation of an additional psychiatric diagnosis
  • Psychiatric or psychological testing for another agency, including a court or school, that does not result in the individual receiving psychiatric intervention or behavioral health therapy from the provider
  • Consultation or educational service provided to a recipient or to others
  • Collateral therapy for an individual aged 21 years or older; 
  • A telephone call, an email, a text message​​ or other electronic contacts that do not meet the requirements stated in the definition of face-to-face, travel time; field trip, recreational activity, a social activity; or physical exercise activity group.
  • A consultation by one provider or professional with another is not covered except regarding collateral outpatient therapy.
  • A third party contract unless a diagnosis is made and documented in the beneficiary medical record within three visits, the service is not covered.

Reimbursement

Reimbursement for BHMSG services is in accordance with the Behavioral Health Fee Schedule and 907 KAR 15:015.

Duplication of Service

The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.

Prior Authorizations

CareWise provides prior authorizations for any fee-for-service beneficiaries. Each MCO provides prior authorization for its beneficiaries.

Claims Submission

Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service claims. Each MCO processes its own claims.

Coding

Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers will need to bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals

Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO in question, if appealing an MCO claim.

Timely Filing

Claims must be received within 12 months of the date of service (DOS) or six months from the Medicare pay date, whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.

Provider Contact Information

If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - 800-292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696
CHFS DMS BH and SU Inquires - (502) 564-6890
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drugs (PAD) list - Pharmacy Branch - (502) 564-6890

Provider MCO Information

Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan - (800) 578-0775
WellCare of KY - (877) 389-9457


Report Fraud and Abuse

(800) 372-2970

Regulations

902 KAR Cabinet for Health and Family Services  - Public Health Title page
902 KAR 20:430 Facilities specifications, operation and Reimbursement for Primary Care services is in accordance with services; behavioral health services organizations
907 KAR 3:130 Medical necessity and clinically appropriate determination basis
907 KAR - Cabinet for Health and Family Services - DMS Title page
907 KAR 15:010 Coverage provisions and requirements regarding behavioral health services provided by individual behavioral health providers, behavioral health provider groups and behavioral health multi-specialty groups
907 KAR 15:015 Reimbursement provisions and requirements for behavioral health services provided by individual behavioral health providers, behavioral health provider groups or behavioral health multi-specialty groups
908 KAR Cabinet for Health and Family Services - Department for Behavioral Health Developmental and Intellectual Disabilities - Title page
908 KAR 1:372  licensing procedures, fees and general requirements for nonhospital-based alcohol and other drug treatment entities
908 KAR 1:374 Licensure of nonhospital-based outpatient alcohol and other drug treatment entities

Provider Resources

Medicaid Assistance Program (MAP) Forms Home 
PT 66 - BHMSG Provider Summary

Provider Letters

Provider Letter #A-106: COVID-19 Guidance - Telehealth 
Provider Letter A-105: COVID-19 Guidance for all Medicaid Providers  

Notification of KY Medicaid Partner Portal Application (KYMPPA) Update 
Multi Behavioral Health Provider Letter - Revisions to Behavioral Health and Substance Abuse Services fee Schedules 
Behavioral Health and Substance Abuse Services Fee Schedules 
General Provider Letter #A-103 - IMD Expansion 
Provider Letter regarding Ordering, Referring Prescribing Providers 

Billing Information

Provider Billing Instruction Home 
BHMSG Provider Billing Instructions

Fee and Rate Schedules

Fee and Rate Schedule Home ​

2022 Behavioral Health and Substance Abuse Services Inpatient (Facility)

2022 Behavioral Health and Substance Abuse Services Outpatient (Non-facility)

2021 Behavioral Health and Substance Abuse Services Inpatient (Facility)

2021 Behavioral Health and Substance Abuse Services Outpatient (Non-facility) 

2020 Behavioral Health and Substance Abuse Services Inpatient (Facility)

2020 Behavioral Health and Substance Abuse Services Outpatient (Non-facility)

Contact Information

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