Appendix MAP Coding-Taxonomy for BH services

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Coding Crosswalk (from rate code to procedure (Px) code and modifiers) for Medicaid Advantage Plus (MAP) Plans Behavioral Health Carve-in Services

Note: Inpatient service and services that are reimbursed using the APG methodology by Medicaid are not included on this spreadsheet. Government rates must be used for Medicaid covered services. Please refer to MAP plans Behavioral Health Billing and Coding Manual for additional details. MAP plans will need to program their payment systems to accept these coding combinations and then look through the Rate Table (https://omh.ny.gov/omhweb/medicaid_reimbursement/) to ascertain the correct payment amount for the various unique coding combinations (specified using procedure codes, modifier codes, and units of service - all cross-walking to rate code) and the specific provider and BH service (based on MMIS provider ID or NPI and rate code).

1-Jul-22

Program Rate Code Rate Code/Service Title Px Code Px Code Description Modifiers Units of Service Specialty Code Notes
Assertive Community Treatment (ACT) 4508 ACT Intensive Full Payment H0040 Assert comm tx pgm per diem None 6+ 816: OMH ACT Billed on a monthly basis. Use per diem code, with number of contacts during month in the unit field. Each unit represent one contact of at least 15 minutes.
4509 ACT Intensive Part Payment H0040 Assert comm tx pgm per diem U5 2-5 816: OMH ACT Billed on a monthly basis. Use per diem code, with number of contacts during month in the unit field. Each unit represent one contact of at least 15 minutes.
4511 ACT Inpatient H0040 Assert comm tx pgm per diem U1, U5 2+ 816: OMH ACT Billed on a monthly basis. Use per diem code, with number of contacts during month in the unit field. Each unit represent one contact of at least 15 minutes.
Continuing Day Treatment (CDT) 4310 Continuing Day Treatment Half Day 1-40 H2012 Behav hlth day treat, per hr U1, U5 2-3 317: OMH CDT 312: CDT (State Op) Billed on a daily basis using three tiers of declining payment, which are derived from the number of hours of service provided previously in the month. Payment is for full day or half day.
4311 Continuing Day Treatment Half Day 41-64 H2012 Behav hlth day treat, per hr U2, U5 2-3 317: OMH CDT
312: CDT (State Op)		 Billed on a daily basis using three tiers of declining payment, which are derived from the number of hours of service provided previously in the month. Payment is for full day or half day.
4312 Continuing Day Treatment Half Day 65+ H2012 Behav hlth day treat, per hr U3, U5 2-3 317: OMH CDT
312: CDT (State Op)		 Billed on a daily basis using three tiers of declining payment, which are derived from the number of hours of service provided previously in the month. Payment is for full day or half day.
4316 Continuing Day Treatment Full Day 1-40 H2012 Behav hlth day treat, per hr U1 4-5 317: OMH CDT
312: CDT (State Op)		 Billed on a daily basis using three tiers of declining payment, which are derived from the number of hours of service provided previously in the month. Payment is for full day or half day.
4317 Continuing Day Treatment Full Day 41-64 H2012 Behav hlth day treat, per hr U2 4-5 317: OMH CDT
312: CDT (State Op)		 Billed on a daily basis using three tiers of declining payment, which are derived from the number of hours of service provided previously in the month. Payment is for full day or half day.
4318 Continuing Day Treatment Full Day 65+ H2012 Behav hlth day treat, per hr U3 4-5 317: OMH CDT
312: CDT (State Op)		 Billed on a daily basis using three tiers of declining payment, which are derived from the number of hours of service provided previously in the month. Payment is for full day or half day.
4325 Continuing Day Treatment Collateral H2012 Behav hlth day treat, per hr UK 1 317: OMH CDT
312: CDT (State Op)		 Billed daily. Payment is based on half day payment for highest CDT tier. Minimum of 30 minutes. 30 minutes counts as one unit in this case.
4331 Continuing Day Treatment Group Collateral H2012 Behav hlth day treat, per hr UK, HQ 1 317: OMH CDT
312: CDT (State Op)		 Billed daily. Payment based on half day payment for highest CDT tier. Minimum of one hour.
4337 Continuing Day Treatment Crisis H2012 Behav hlth day treat, per hr U8 1 317: OMH CDT
312: CDT (State Op)		 Billed daily. Payment is based on half day payment for highest CDT tier. No minimum duration.
4346 Continuing Day Treatment Pre-Admission H2012 Behav hlth day treat, per hr U9 1 317: OMH CDT
312: CDT (State Op)		 Billed daily. Payment is based on half day payment for highest CDT tier. Minimum of one hour.
Comprehensive Psychiatric Emergency Program (CPEP) 4007 Brief Evaluation 90791 Psych Dx Eval (code also used in OMH Clinic) HK, U5 1 992: OMH CPEP Known as "brief emergency visit". Billed on a daily basis.
4008 Full Evaluation 90791 Psych Eval (code also used in OMH Clinic) HK 1 992: OMH CPEP Known as "full emergency visit". Billed on a daily basis.
4009 Crisis Outreach Visit S9485 Crisis Intervention mental health services, per diem HK 1 992: OMH CPEP These are emergency services provided outside an emergency room setting. Code also pays in HCBS and APGs so use the HK modifier to differentiate the claim. Billed daily.
4010 Interim Crisis Visit H0037 Comm psy sup tx pgm per diem HK 1 992: OMH CPEP These are emergency services provided outside an emergency room setting to persons released from CPEP. Code also pays in APGs. Billed daily.
4049 Extended Observation Beds (EOB)   See note (to the right).     992: OMH CPEP Use same coding rules as used with rate code 2852 (inpatient psych per diem).
Partial Hospitalization (PH) 4349 Partial Hospitalization Regular - 4 hours H0035 MH partial hosp tx under 24h U4, [UA] 4 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 4 units. This code does not pay in APGs. Add the UA modifier if the service is a pre-admission.
4350 Partial Hospitalization Regular - 5 hours H0035 MH partial hosp tx under 24h U5, [UA] 5 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 5 units. This code does not pay in APGs. Add the UA modifier if the service is a pre-admission.
4351 Partial Hospitalization Regular - 6 hours H0035 MH partial hosp tx under 24h U6, [UA] 6 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 6 units. This code does not pay in APGs. Add the UA modifier if the service is a pre-admission.
4352 Partial Hospitalization Regular - 7 hours H0035 MH partial hosp tx under 24h U7, [UA] 7 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 7 units. This code does not pay in APGs. Add the UA modifier if the service is a pre-admission.
4353 Partial Hospital Collateral - 1 hour H0035 MH partial hosp tx under 24h U1, HR or HS 1 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 1 unit. Use HR or HS modifier (in addition to U1). This code does not pay in APGs.
4354 Partial Hospital Collateral - 2 hours H0035 MH partial hosp tx under 24h U2, HR or HS 2 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 2 units. Use HR or HS modifier (in addition to U2). This code does not pay in APGs.
4355 Partial Hospital Group Collateral - 1 hour H0035 MH partial hosp tx under 24h U1, HQ, HR or HS 1 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 1 unit. Use HQ (group) modifier. Also use HR or HS modifier (in addition to HQ and U1). This code does not pay in APGs.
4356 Partial Hospital Group Collateral - 2 hours H0035 MH partial hosp tx under 24h U2, HQ, HR or HS 2 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Billed daily. Code with 2 units. Use HQ (group) modifier. Also use HR or HS modifier (in addition to HQ and U2). This code does not pay in APGs.
4357 Partial Hospitalization Crisis - 1 hour S9484 Crisis intervention per hour HK, U1, [UA] 1 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim from clinic (APGs). Billed daily. Add the UA modifier if the service is a pre-admission.
4358 Partial Hospitalization Crisis - 2 hours S9484 Crisis intervention per hour HK, U2, [UA] 2 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim from clinic (APGs). Billed daily. Add the UA modifier if the service is a pre-admission.
4359 Partial Hospitalization Crisis - 3 hours S9484 Crisis intervention per hour HK, U3, [UA] 3 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim from clinic (APGs). Billed daily. Add the UA modifier if the service is a pre-admission.
4360 Partial Hospitalization Crisis - 4 hours S9484 Crisis intervention per hour HK, U4 4 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim from clinic (APGs). Billed daily.
4361 Partial Hospitalization Crisis - 5 hours S9484 Crisis intervention per hour HK, U5 5 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim. Billed daily.
4362 Partial Hospitalization Crisis - 6 hours S9484 Crisis intervention per hour HK, U6 6 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim from clinic (APGs). Billed daily.
4363 Partial Hospitalization Crisis - 7 hours S9484 Crisis intervention per hour HK, U7 7 318: OMH Partial Hosp 313: OMH Partial Hosp (S.O.) Also pays in APGs. Use HK modifier to differentiate claim from clinic (APGs). Billed daily.
Personalized Recovery Oriented Services (PROS) 4510 PROS Preadmission H0002 Behavioral health screening, admission eligibility HE 1 829: OMH PROS Billed monthly. Limited to 2 consecutive months. Cannot be billed in same month as PROS monthly base rate services code or other PROS rate codes. This code pays in APGs. Use HE modifier to differentiate claim from clinic (APGs).
4520 PROS Comm Rehab Srvcs 2-12 Units H2019 Ther behav svc, per 15 min U1 2-12 829: OMH PROS Billed monthly. The PROS units for the month are determined by using the "PROS Unit Conversion Chart" on a daily basis and then totaling for the month. Use the per diem code and show total PROS units for the month. The number of units coded does not affect payment, as payment is the same throughout the range.
4521 PROS Comm Rehab Srvcs13-27 Units H2019 Ther behav svc, per 15 min U2 13-27 829: OMH PROS Billed monthly. The PROS units for the month are determined by using the "PROS Unit Conversion Chart" on a daily basis and then totaling for the month. Use the per diem code and show total PROS units for the month. The number of units coded does not affect payment, as payment is the same throughout the range.
4522 PROS Comm Rehab Srvcs 28-43 Units H2019 Ther behav svc, per 15 min U3 28-43 829: OMH PROS Billed monthly. The PROS units for the month are determined by using the "PROS Unit Conversion Chart" on a daily basis and then totaling for the month. Use the per diem code and show total PROS units for the month. The number of units coded does not affect payment, as payment is the same throughout the range.
4523 PROS Comm Rehab Srvcs 44-60 Units H2019 Ther behav svc, per 15 min U4 44-60 829: OMH PROS Billed monthly. The PROS units for the month are determined by using the "PROS Unit Conversion Chart" on a daily basis and then totaling for the month. Use the per diem code and show total PROS units for the month. The number of units coded does not affect payment, as payment is the same throughout the range.
4524 PROS Comm Rehab Srvcs 61+ Units H2019 Ther behav svc, per 15 min U5 61+ 829: OMH PROS Billed monthly. The PROS units for the month are determined by using the "PROS Unit Conversion Chart" on a daily basis and then totaling for the month. Use the per diem code and show total PROS units for the month. The number of units coded does not affect payment, as payment is the same throughout the range.
4525 PROS Clin Trmt Add-On Medicare procedure code 1 829: OMH PROS Medicaid Rate Code + Medicare Procedure Code/Revenue Code.

Notes: Currently PROS clinic in MAP is reimbursed at Medicare negotiated rate, and Medicaid only pays cost-sharing.
Effective January 2023, MAP plans will pay the "higher of" Medicare and Medicaid rate for PROS clinic services and procedures that are allowable under both Medicare and Medicaid, and will pay Medicaid rate if the service and the professional performing the service are allowable under Medicaid, but not allowable under Medicare.
4526 PROS Int Rehab H2018 Psysoc rehab svc, per diem HE 1 829: OMH PROS Billed monthly. Requires at least 6 units of PROS in the CRS base (billed on separate line using H2019 - and showing total PROS units for the month). These two "base" units could include CRS, Clinic, Intensive Rehab, or ORS. Show only 1 unit on this line.
4527 PROS Ongoing Rehab & Support H2025 Supp maint employ, 15 min HE 1 829: OMH PROS Requires at least 2 units of PROS in the CRS base (billed on separate line using H2019 - and showing total PROS units for the month). These two "base" units could include CRS, Clinic, IR, or ORS. Show only 1 unit on this line.
4531 Pre-admission - AH/NH/PC H0002 Behavioral health screening, admission eligibility UB, HE 1 829: OMH PROS Billed monthly. Used instead of rate code 4510, but only for the BIP population. Limited to 4 (instead of only 2) consecutive months. Cannot be billed in same month as PROS monthly base rate services code or other PROS rate codes. This code pays in APGs. Use HE modifier to differentiate claim from clinic (APGs).
4532 Enhanced CRS 2 Contact - AH/NH/PC H2019 Ther behav svc, per 15 min UB, U2 1 829: OMH PROS This is a monthly add-on to the base rate and can be billed in combination with other add-ons. Two or three services are required (see billing manual), but use one (1) as the billing unit.
4533 Enhanced CRS 4 Contact - AH/NH/PC H2019 Ther behav svc, per 15 min UB, U4 1 829: OMH PROS This is a monthly add-on to the base rate and can be billed in combination with other add-ons. Four or more services are required (see billing manual), but use one (1) as the billing unit.
4534 Intensive Rehabilitation - AH/NH/PC H2018 Psysoc rehab svc, per diem UB, HE 1 829: OMH PROS This code is used in place of 4526 for the BIP population. The billing requirements are the same as 4526, but also include the UB modifier.
Telephonic Crisis 4609 Telephonic crisis response - Licensed (up to 90 min) H2011 Crisis Intervention service, per 15 min GT 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Telephonic Crisis.
4610 Telephonic crisis response (up to 90 min) - unlicensed Masters level H2011 Crisis Intervention service, per 15 min GT, HO 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Telephonic Crisis.
4611 Telephonic crisis response - Licensed (Above 90 min - 3 hours) S9485 Crisis Intervention service, per diem GT 1/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Telephonic Crisis.
4612 Telephonic crisis response - unlicensed Masters level (Above 90 min - 3 hours) S9485 Crisis Intervention service, per diem HO 1/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Telephonic Crisis.
4613 Telephonic Crisis follow up - Licensed H2011 Crisis intervention service, per 15 minutes TS, GT 4/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Telephonic Crisis.
4614 Telephonic Crisis follow up - Certified Peer H2011 Crisis intervention service, per 15 minutes TS, HM 4/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Telephonic Crisis.
Mobile Crisis Response MCR 4615 Mobile crisis response - one person response, Licensed - up to 90 min H2011 Crisis Intervention service, per 15 min HE 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4616 Mobile crisis response - two person response - Licensed and Unlicensed/Certified Peer- up to 90 minutes H2011 Crisis Intervention service, per 15 min HK 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4617 Mobile crisis response - two person response, both Licensed - up to 90 minutes H2011 Crisis Intervention service, per 15 min HE, HK 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4618 Mobile Crisis Response (90 - 180 minutes) Two person response - Licensed and Unlicensed/Certified Peer S9485 Crisis intervention mental health services, per diem HE, U5 1/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4619 Mobile Crisis Response (90 - 180 minutes) Two person response, both Licensed S9485 Crisis intervention mental health services, per diem HE, HK, U5 1/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4620 Mobile Crisis Response- Per Diem Requires a minimum 3 hours of face-to-face contact - Two person response, Licensed and Unlicensed/Certified Peer S9485 Crisis intervention mental health services, per diem HE 1/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4621 Mobile Crisis Response- Per Diem. Requires a minimum 3 hours of face-to-face contact - Two person response, both Licensed. S9485 Crisis Intervention mental health service, per diem HE, HK 1/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4622 Crisis follow up - face to face - One person response, Licensed - up to 90 minutes H2011 Crisis intervention service, per 15 minutes TS 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4623 Crisis follow up - face to face - One person response, Unlicensed/Certified Peer - up to 90 minutes H2011 Crisis intervention service, per 15 minutes TS, HE 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
4624 Crisis follow up - face to face - Two person response, one Licensed and one Unlicensed/Certified Peer - up to 90 minutes H2011 Crisis intervention service, per 15 minutes TS, SC 6/Day 824 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Mobile Crisis Response
Residential Crisis Support (RCS) 4625 Residential Crisis Support (RCS) T2034 Crisis intervention, waiver; per diem HE 1/Day 365 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Residential Crisis Services.
Intensive Crisis Support (ICR) 4626 Intensive Crisis Residence (ICR) T2034 Crisis intervention, waiver; per diem ET 1/Day 365 Billed daily, use CPT and modifier combination to differentiate between services. This service is a part of Residential Crisis Services.
Community Oriented Recovery and Empowerment (CORE) 7784 1115 Psychosocial Rehab - Indv - on-site H2017 Psychosocial rehabilitation services; per 15 minutes U1   836 On-site rate code. Use U1 modifier. Do not bill transportation supplement.
7785 1115 Psychosocial Rehab - Indv - off-site H2017 Psychosocial rehabilitation services; per 15 minutes U2   836 Off-site rate code. Use U2 modifier. Bill transportation supplement as appropriate.
7810 Psychosocial Rehabilitation- Employment Focus (On-site or Off-site) H2017 Psychosocial rehabilitation services; per 15 minutes     836 Service must be one-to-one. Bill transportation supplement as appropriate.
7811 Psychosocial Rehabilitation- Education Focus (On-site or Off-site) H2017 Psychosocial rehabilitation services; per 15 minutes TF   836 Service must be one-to-one. Bill transportation supplement as appropriate.
7786 1115 Psychosocial Rehab - Group 2-3 H2017 Psychosocial rehabilitation services; per 15 minutes UN or UP Add TF if with Education Focus Add TG if with Employment Focus   836 On-site or off-site. Use appropriate modifier. Bill staff transportation supplement as appropriate (but only for a single recipient).
7787 1115 Psychosocial Rehab - Group 4-5 H2017 Psychosocial rehabilitation services; per 15 minutes UQ or UR Add TF if with Education Focus Add TG if with Employment Focus   836 On-site or off-site. Use appropriate modifier. Bill staff transportation supplement as appropriate (but only for a single recipient).
7788 1115 Psychosocial Rehab - Group 6-10 H2017 Psychosocial rehabilitation services; per 15 minutes US Add TF if with Education Focus Add TG if with Employment Focus   836 On-site or off-site. Use appropriate modifier. Bill staff transportation supplement as appropriate (but only for a single recipient). Maximum group size is 10.
7790 1115 CPST (physician) H0036 Community Psychiatric Supportive Treatment, face-to-face; per 15 min AF   839 Off-site only. Use appropriate modifier. Bill transportation separately. No groups.
7791 1115 CPST (NP, Psychologist, Physician's Assistant) H0036 Community Psychiatric Supportive Treatment, face-to-face; per 15 min Use SA modifier for Nurse Practitioner or AH modifier for Psychologist or U1 modifier for Physician's Assistant   839 Off-site only. Use appropriate modifier. Bill transportation separately. No groups.
7792 1115 CPST (RN, LMHC/MHC-LP, LMFT/MFT-LP, LCSW, LMSW/MSW-LP, LCAT/CAT-LP, Psychoanalyst, CRC) H0036 Community Psychiatric Supportive Treatment, face-to-face; per 15 min Use TD modifier for Registered Nurse or AJ modifier for all other allowable professions   839 Off-site only. Use appropriate modifier. Bill transportation separately. No groups.
7793 1115 CPST (LPN) H0036 Community Psychiatric Supportive Treatment, face-to-face; per 15 min     839 Off-site only. Bill transportation separately. No groups.
7794 1115 Peer Supports - by credentialed staff H0038 Self Help / Peer Services, per 15 minutes HE or HF   837 On-site or off-site. Use HE modifier for an "OMH service" or the HF modifier for an "OASAS service". Bill transportation supplement as appropriate.
7799 1115 Family Support / Training (individual) H2014 Skills training and development; per 15 minutes HR or HS   855 On-site or off-site. Bill transportation supplement as appropriate. Use modifiers. No modifier is needed if FST is delivered one-on-one with the individual only.
7800 1115 Family Support / Trn (group of 2 or 3) H2014 Skills training and development; per 15 minutes HR or HS, UN or UP   855 On-site or off-site. Bill transportation supplement as appropriate. Use modifiers.
7808 1115 Provider Travel Supplement (per mile) A0160 Non-emergency transportation: per mile - case worker or social worker U2 1-60/day/round trip 835 Billing is at the recipient level. 58 cents (per Federal guidelines). Billed on a daily basis. Only one claim is allowed per recip per day.
7809 1115 Provider Travel Supplement (public transport) A0160 Non-emergency transportation: per mile - case worker or social worker U3 31/month 835 Billing is at the recipient level. Bill monthly. Use first day of the month as the date of service.