Magellan recently sent the message below, and this is consistent with what was said in the 11/1/18 Webinar with DMAS. Stay tuned for changes from Medicaid as the redesign happens, but you will not be able to bill DMAS for the new CPT codes in January through any of the six MCOs. Just continue using the H codes as dictated in the manual.
Behavioral Therapy providers may have heard about some coding changes taking place January 1, 2019. The American Medical Association (AMA) has issued new CPT®assessment and treatment codes for the applied behavior analysis, beginning in 2019.
For Magellan of Virginia, these changes do not impact Behavioral Therapy services rendered to Virginia Medicaid members. The current codes, H0032 UA for the assessment and H2033 for the service, will remain billable codes on and after January 1, 2019. Behavioral Therapy providers contracted with Magellan of Virginia should continue to use H0032 UA and H2033 on and after January 1, 2019 for reimbursement. The Department of Medical Assistance Services (DMAS) is in review of the new CPT codes for future use with Magellan of Virginia for Behavioral Therapy. The Medicaid Managed Care Organizations (MCOs) recognize these codes and may also recognize the new CPT codes in certain circumstances. Providers should contact the specific Medicaid MCO for more information.
The reimbursement schedule with covered codes can be found on the Magellan of Virginia website here.
Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) Therapeutic Group Homes and EPSDT Psychiatric Residential Treatment providers that submit claims to Magellan of Virginia for codes 0359T, 0360T, 0361T, 0370T or 0371T will be impacted. Magellan will send a communication in the near future outlining the specific changes that pertain to dates of service 1/1/2019 and later. You can continue to bill codes 0359T, 0360T, 0361T, 0370T or 0371T for dates of service 12/31/2018 and earlier.
As a reminder: If your practice adds a new service location or adds Behavioral Therapy services to an existing location, you must notify a Magellan network representative to have your Magellan agreement amended to add the new service location or level of care. Contract changes must occur prior to rendering and billing for services. Claims submissions for Behavioral Therapy services rendered prior to the contract changes taking effect may be denied if you do not notify Magellan in advance about the changes to your practice.
If you have any questions, please contact the Network department at 1-800-424-4536 or send an email to VAProviderQuestions@magellanhealth.com.