SPECIAL BULLETIN COVID-19 #76: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Behavioral Health Service Flexibilities – (b)(3) Services

Friday, May 1, 2020

Effective April 30, 2020, NC Medicaid in partnership with the DHHS 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. 

These temporary changes are retroactive to March 10, 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the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.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 or telephonic modalities. 
  • Providers must consider an individual’s behavioral, physical and cognitive abilities to participate in services provided using telehealth or telephonic 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 or telephonic services, their ability to assist and their safety should also be considered when the individual needs physical assistance. 
  • 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.

Table 1: Behavioral Health (b) (3) Emergency Flexibilities by Service

Procedure Code

Service

Emergency Flexibilities

H2023 U4
H2026 U4


HQ for group

Supported Employment (Initial and Maintenance)

  • For Supported Employment for individuals with Mental Health needs, (b)(3) follows the State definition. *
  • For Supported Employment for individuals with Mental Health needs, Service may be provided via two-way, real-time audio and video - as well as telephonically.
  • For Supported Employment for individuals with I/DD, (b)(3) follows the NC Innovations waiver definition. **
  • For Supported Employment for individuals with I/DD, Service may be provided via two-way, real-time audio and video.

T1019 U4

Individual Support

H2022 U4

Transitional Living Skills

  • Service may be provided via two-way, real-time audio and video as well as telephonically.

T1012 U4

Intensive Recovery Supports

  • Service may be provided via two-way, real-time audio and video as well as telephonically.

T2013 U4

In Home Skill Building

  • Service may be provided via two-way, real-time audio and video.

Waiver Code U4

NC Innovations waiver services

  • Flexibilities are the same as those offered under the NC Innovations waiver.**

H0043

One Time Transitional Cost

Please note that which there are no additional flexibilities to this service, the waiver amendment removed the requirement that this service be provided within 3 months after the discharge date.

*For information on flexibilities for Supported Employment for individuals with Mental Health needs, please see SPECIAL BULLETIN COVID-19 #60: Fidelity Reviews Delayed for Current Individual Placement and Support (IPS) and Assertive Community Treatment (ACT) Teams

** For NC Innovations waiver flexibilities, please see the following bulletins:

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 (b) (3) Emergency Flexibilities Modifier Guidance

Procedure Code

Procedure Code Description

COVID-19 Flexibility

H2023 U4
H2026 U4


HQ for group

Supported Employment (Initial and Maintenance)

  • No modifier when done per established policy.
  • Modifier GT and CR when done via two-way, real time, audio and visual communication.
  • Modifier CR when using any of temporary flexibilities/waivers in the State definition or the NC Innovations waiver definition.

T1019 U4

Individual Support

  • No modifier when done per established policy.
  • Modifier GT and CR when done via two-way, real time, audio and visual communication.
  • Modifier CR when done telephonically.

H2022 U4

Transitional Living Skills

  • No modifier when done per established policy.
  • Modifier GT and CR when done via two-way, real time, audio and visual communication.
  • Modifier CR when done telephonically.

T1012 U4

Intensive Recovery Supports
  • No modifier when done per established policy.
  • Modifier GT and CR when done via two-way, real time, audio and visual communication.
  • Modifier CR when done telephonically.

T2013 U4

In Home Skill Building

  • No modifier when done per established policy.
  • Modifier GT and CR when done via two-way, real time, audio and visual communication.
  • Modifier CR when done telephonically.

Waiver Code + U4

NC Innovations waiver services

  • Flexibilities are the same as those offered under the NC Innovations waiver. ***

H0043

One Time Transitional Cost

  • No modifier per changes.

*** For modifiers applicable to NC Innovations waiver flexibilities, please see 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

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.

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