California Code of Regulations
Title 9 - Rehabilitative and Developmental Services
Division 1 - Department of Mental Health
Chapter 11 - Medi-Cal Specialty Mental Health Services
Subchapter 4 - Federal Financial Participation
Article 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services
Section 1840.304 - Crosswalk Between Service Functions and HCPCS Codes
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) When an individual or group provider bills and is paid by the MHP for psychiatrist, psychologist, or EPSDT supplemental specialty mental health services using CPT or other HCPCS codes, the MHP shall claim FFP by service function based on a crosswalk between allowable CPT and other HCPCS codes and service functions established by the Department pursuant to the contract between the MHP and the Department. The dollar amount claimed shall be in accordance with Section 1840.105.
(b) When a provider that is a hospital outpatient department bills and is paid by the MHP for facility room use using the HCPCS codes Z7500 or Z7502 in addition to the CPT or other HCPCS code for the specialty mental health service provided to the beneficiary, the MHP shall claim FFP for the combined codes under the CPT or other HCPCS codes for the specialty mental health service provided to the beneficiary that are listed on the crosswalk established pursuant to the contract between the MHP and the Department as specified in Subsection (a). When a provider bills the MHP using a CPT or other HCPCS code that is not included on the crosswalk established pursuant to the contract between the MHP and the Department as specified in Subsection (a) other than Z7500 or Z7502, the MHP shall determine the appropriate service function for the service provided and shall claim FFP in accordance with Section 1840.308.
(c) The HCPCS codes listed on the crosswalk established pursuant to the contract between the MHP and the Department as specified in Subsection (a) may be billed by any individual or group providers acting within the scope of their practice.
(d) The lockouts described in Section 1840.215 and Sections 1840.360 through 1840.374 shall apply to claiming of FFP for services claimed under this Section. For the purpose of determining lockouts the service shall be considered to be the service function identified on the crosswalk established pursuant to the contract between the MHP and the Department as specified in Subsection (a).
(e) The crosswalk established pursuant to the contract between the MHP and the Department as specified in Subsection (a) shall not be used to claim FFP for services provided by organizational providers.
1. New section
filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A
Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language
will be repealed by operation of law on the following day.
2. New section
refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A
Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency
language will be repealed by operation of law on the following day.
3.
New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No.
25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate
of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be
repealed by operation of law on the following day.
4. Editorial
correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction
extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50
(Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any
other provision of law, emergency regulations adopted pursuant to Welfare and
Institutions Code section
14680
to implement the second phase of mental health managed care as provided in this part
shall remain in effect until permanent regulations are adopted, or June 30, 2006,
whichever occurs first.
6. Editorial correction of HISTORY 5 (Register
2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new
section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 5778, Welfare and Institutions Code.
