Guidance for Section 65 Medication Management Code Changes and Duplication with Intensive Outpatient Programs (IOP)

MaineCare is not removing H2010 HF

MaineCare previously sent a notice saying we will remove H2010 HF from Atrezzo, but we decided not to go forward with this change. This means medication management providers do not need to discharge members from authorizations for H2010 HF in Atrezzo by November 12, 2025. You may continue to use this code and modifier for medications for opioid use disorder (MOUD) medication management.

Reasons for Not Removing the Code and Modifier

We understand that MaineCare members may have two authorizations from two providers for medication management: one for psychiatric medications, and one for medications for opioid use disorder (MOUD), so we decided to keep the H2010 HF code active so providers can use it when they deliver only MOUD medication management to both adults and children.

Additional Code and Modifier Guidance

Providers should bill H2010 (for adults) and H2010 HA (for children) for medication management of all medications, which include managing both psychiatric medications and MOUD.

Do not use these codes if you are ONLY managing MOUD. Use H2010 HF when managing MOUD ONLY for both adults and children.

Co-occurring Capable Provider Medication Management

Whenever possible, members who require psychiatric medications and MOUD should receive medication management from one co-occurring capable provider who can manage both types of medications. If a member  needs medication management for psychiatric medications and MOUD, but cannot be served by a co-occurring capable provider, two providers may have separate authorizations for medication management for the same MaineCare member.

IOP Services and Medication Management

IOP services covered under Section 65 include medication management. As a result, whether providers may bill for medication management delivered to a member while they receive IOP services depends on the type of medications and IOP. See the table below.

 

Mental Health IOP, Developmental Disability and Behavioral Health IOP, Geriatric IOP, Dialectical Behavior Therapy IOP, and Level I and II Eating Disorder IOP

Substance Use IOP

Medication Management for psychiatric medications (H2010 and H2010 HA)

Cannot be billed concurrently

May be billed concurrently

Medication Management for MOUD (H2010 HF)

May be billed concurrently

Cannot be billed concurrently

Medication Management from one provider for BOTH psychiatric medications and MOUDs (H2010 and H2010 HA)

Providers may not bill for medication management for psychiatric medications for members in the above IOPs. Providers may continue to bill for medication management for MOUD using the existing authorization for H2010 and H2010 HA.

Providers may not bill for medication management for MOUDs for members in Substance Use IOPs. Providers may continue to bill for medication management for psychiatric medications.

 

Duplicative IOP Service Clarification

If a member receives medication management that the provider can no longer bill because the member receives duplicative IOP services, the provider does not need to discharge the member or end the authorization. The authorization may continue, so the member can begin receiving services once they are discharged from the IOP.

IOP Provider Consultation

As a reminder, if an IOP provider consults a medication management provider, the medication management provider may bill for interprofessional consultations. See the Interprofessional Codes for Medication Management Providers e-message for more details.

Previous Notices from MaineCare

These notices clarify and provide additional guidance:

For questions, please contact Pam Grotton, Provider Relations Specialist.