SPECIAL BULLETIN COVID-19 #75: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Behavioral Health Service Flexibilities – Innovations and TBI Waivers Appendix K and Developmental Disability State Funded Benefit Plans

<p>Effective April 30, 2020, NC Medicaid in partnership with the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability (I/DD) Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.&nbsp;</p>

Update (June 17, 2020)

  • In Table 1, Procedure Code YP660 has been added. Procedure Code YP021 was listed in error and is no longer billable in NCTracks. Procedure Code YP390 has been placed with the correct Procedure Code YM390.  
  • In Table 2, Procedure Code YP660 has been added. Procedure Code YP021 was listed in error and is no longer billable in NCTracks. Procedure Code YP390 has been placed with the correct Procedure Code YM390.  
     

Background and General Guidance

Effective April 30, 2020, NC Medicaid in partnership with the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability (I/DD) Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic. 

The temporary changes outlined below are to services offered under the 1915 (c) and the child and adult Developmental Disability State Funded benefit plans. The changes are retroactive to March 13, 2020 and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded. When the temporary modifications end, all prior service requirements will resume.  

During the North Carolina declared state of emergency, services must continue to be provided at an intensity and quality that meet the needs of the individual, consistent with the individual’s goals and the intended outcomes of the service. In addition, the service must be provided in the most appropriate way to meet the needs of each individual.  

Throughout this bulletin, “telehealth” means two-way real-time interactive audio and video to provide care and services when participants are in different physical locations. Telehealth does not include telephonic provision of services; when telephonic provision is permitted, it is specifically noted below. 

  • Providers must ensure that services outlined in this bulletin can be safely and effectively delivered using telehealth modalities. 
  • Providers must consider an individual’s behavioral, physical and cognitive abilities to participate in services provided using telehealth interventions. 
  • The individual’s safety must be carefully considered for the complexity of the services provided. In situations where caregivers or facilitators are necessary to assist with the delivery of telehealth services, their ability to assist and their safety should also be considered when the individual needs physical assistance. 
  • Telehealth provision of NC Innovations waiver, NC Traumatic Brain Injury (TBI) waiver and 1915(b)(3) NC Innovations services may only be used when it is clinically indicated for the individual, the individual needs only verbal cueing or prompting to complete tasks and there are no other health and safety issues.
  • Delivery of services using telehealth or telephonic interventions must conform to professional standards including, but not limited to, ethical practice, scope of practice, and other relevant federal, state and institutional policies and requirements including relevant Practice Acts and Licensing Board rules.

The following tables outline the allowed service flexibilities during this declared state of emergency.

Table 1: Behavioral Health Service Flexibilities – NC Innovations waiver, NC TBI waiver,1915 (b)(3) NC Innovations services and State Funded I/DD – Guidance on Telehealth and Telephonic Service Delivery 

Procedure Code

Service

T2027

Day Supports - Developmental Day
  • Service may be provided via telehealth.

T2021
T2021 HQ

Day Supports - Individual and Group (Innovations and TBI)

T2013 TF
T2013 TF HQ

Community Living and Supports - Individual and Group (Innovations)
  • Service may be provided via telehealth.

H2015
H2015 HQ

Community Networking - Individual and Group (Innovations and TBI)
  • Service may be provided via telehealth.

H2025
H2025 HQ

Supported Employment - Individual and Group (Innovations and TBI)
  • Service may be provided via telehealth.

H2025 TS
H2025 TS HQ

Supported Employment – Long Term Follow-up (Innovations)
  • Service may be provided via telehealth.

T2033
T2033 HI
T2033 TF

Supported Living – Level 1, Level 2, Level 3 (Innovations)
  • Service may be provided via telehealth.

S5102

Adult Day Health (TBI)
  • Service may be provided via telehealth.

S5125

Personal Care (TBI)
  • Service may be provided via telehealth.

T1015

In Home Intensive (TBI)
  • Service may be provided via telehealth.

T2013
T2013 HQ

Life Skills Training - Individual and Group (TBI)
  • Service may be provided via telehealth.

97532

Cognitive Rehabilitation (TBI)
  • Service may be provided via telehealth.

Waiver Code U4

1915 (b)(3) NC Innovations waiver services
  • Service may be provided via telehealth. Flexibilities are the same as those offered under NC Innovations as outlined above.

T2041

Resource Facilitation (TBI)
  • Service may be provided via telehealth. It can also be provided telephonically per the policy.

S5110

Natural Supports Education (Innovations and TBI)
  • Service may be provided via telehealth. It can also be provided telephonically per the policy.

T2025

Specialized Consultative Services (Innovations and TBI)
  • Service may be provided via telehealth.  It can also be provided telephonically per the policy.

T2041

Community Navigator (Innovations)
  • Service may be provided via telehealth.  It can also be provided telephonically per the policy.

YP620

Adult Developmental Vocational Program (ADVP)
  • Service may be provided via telehealth.

YP660

Day/Evening Activity

  • Service may be provided via telehealth.

YM580

Day Supports
  • Service may be provided via telehealth.

YP610

Developmental Day
  • Service may be provided via telehealth

YA389

Long-Term Vocational Support Services (Extended Services-IDD)
  • Service may be provided via telehealth

YP020 - Ind

Personal Assistance
  • Service may be provided via telehealth.

YM050

Personal Care Services

  • Service may be provided via telehealth.

YM390 - Ind

YP640 - Group

Supported Employment-IDD
  • Service may be provided via telehealth.

Extended State Plan Occupational Therapy, Physical Therapy, and Speech Therapy should be provided per the guidelines for Specialized Therapies outlined in SPECIAL BULLETIN COVID-19 #36: Telehealth Clinical Policy Modifications – Outpatient Specialized Therapies and Dental Services.

Modifiers

Provider(s) shall follow applicable modifier guidelines.

  • Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive two-way real-time audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal. 
  • Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT and HCPCS codes listed in this policy to relax frequency limitations defined in code definitions. 
  • Detailed guidance on modifiers by procedure code is included in the table below. 

Table 2: Behavioral Health Service Flexibilities –NC Innovations waiver, NC TBI waiver, 1915(b)(3) NC Innovations Services and State Funded I/DD Services – Guidance on Telehealth and Telephonic Service Delivery Modifier Guidance.

Procedure Code

Service

Modifier Guidance

T2027

Day Supports - Developmental Day
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

T2021
T2021 HQ

Day Supports - Individual and Group (Innovations and TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

T2013 TF
T2013 TF HQ

Community Living and Supports - Individual and Group (Innovations)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

H2015
H2015 HQ

Community Networking - Individual and Group (Innovations and TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

H2025
H2025 HQ

Supported Employment - Individual and Group (Innovations and TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

H2025 TS
H2025 TS HQ

Supported Employment – Long Term Follow-up (Innovations)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

T2033
T2033 HI
T2033 TF

Supported Living – Level 1, Level 2, Level 3 (Innovations)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

S5102

Adult Day Health (TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

S5125

Personal Care (TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

T1015

In Home Intensive (TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

T2013
T2013 HQ

Life Skills Training - Individual and Group (TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

97532

Cognitive Rehabilitation (TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth.

Waiver Service U4

1915 (b)(3) NC Innovations waiver services
  • Use modifier changes as outlined for each service above.

T2041

Resource Facilitation (TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

S5110

Natural Supports Education (Innovations and TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

T2025
T2025 HO

Specialized Consultative Services (Innovations and TBI)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

T2041

Community Navigator (Innovations)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YP620

Adult Developmental Vocational Program (ADVP)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YP660

Day/Evening Activity

  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YM580

Day Supports
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YP610

Developmental Day
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YA389

Long-Term Vocational Support Services (Extended Services-IDD)
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YP020 - Ind

Personal Assistance
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YM050

Personal Care Services

  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

YM390 - Ind

YP640 - Group

Supported Employment-IDD
  • No modifier when done per established policy.
  • Modifier GT and CR when done via telehealth

Billing Unit

Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).

Place of Service

Telemedicine and telepsychiatry claims related to COVID-19 shall be filed following the guidance of the LME-MCO.

Additional Resources

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