Updated Billing Guidance for Section 28 Providers
This notice clarifies and updates the Department's guidance on December 31, 2024.
Providers of Specialized Services cannot bill for any time a Board-Certified Behavior Analyst (BCBA) spends delivering services, including, but not limited to, the BCBA Services outlined in MaineCare Benefits Manual (MBM) Section 28.04-3.
Providers should only bill HCPCS H2021 for the time the BHP delivers direct services, as described in Section MBM 28.04-2.
The reimbursement rates that providers receive by billing HCPCS code H2021– Specialized Services for the Behavioral Health Professional (BHP) direct services include reimbursement for the full cost of the BCBA. This means providers cannot bill any code, including HCPCS G9007 and HCPCS H2021, for any time the BCBA spends delivering services.
Section 28 providers that previously billed for BCBA service time through HCPCS G9007 or H2021 do not have to adjust or reverse those claims.
For questions, please contact Pam Grotton, Provider Relations Specialist.
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