Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.59 - Specialty Mental Health Services
Section 10.09.59.09 - Payment Procedures

Universal Citation: MD Code Reg 10.09.59.09

Current through Register Vol. 51, No. 19, September 20, 2024

A. Payment procedures shall be followed as specified in COMAR 10.09.36.04.

B. A provider shall deliver and document services in accordance with Department regulations in order to receive reimbursement.

C. Unless the care is free to other patients, a provider shall bill the Program its usual and customary charge to the general public.

D. The Department shall authorize supplemental payment on Medicare claims only if:

(1) The provider accepts Medicare assignments;

(2) Medicare makes direct payment to the provider;

(3) Medicare has determined that the services are medically necessary;

(4) The services are covered by the Program; and

(5) Initial billing is made directly to Medicare according to Medicare guidelines.

E. The Department shall make payment on Medicare claims subject to the following provisions:

(1) Deductible and coinsurance shall be paid in full for services designated as mental health services by Medicare; and

(2) The Program shall reimburse services not covered by Medicare, but considered medically necessary by the Program, according to the limitations of this chapter.

F. A provider may not bill the Program for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Professional services rendered by mail or telephone; or

(4) Services not authorized consistent with Regulation .08 of this chapter.

G. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.

H. The Department shall reimburse providers according to the fee schedule in COMAR 10.21.25.

I. Psychiatric rehabilitation programs shall identify the mental health professional who referred the individual to psychiatric rehabilitation services by recording the individual practitioner's National Provider Identifier (NPI) number on the claim.

Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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