29-I Health Facility Billing Manual Update – Procedure Code 98016
TO: ARTICLE 29-I VFCA HEALTH FACILITY PARTICIPATING PROVIDERS
IMPACTED PLANS: MEDICAID and HIV SNP
Dear MetroPlusHealth Provider,
Effective as of January 1, 2025, the Office of Mental Health has released notice to the 29-I Health Facility Billing Manual, to support the recent American Medical Association (AMA) coding update.
Procedure code 98016 has been added to the allowable billing code for Article 29-I VFCA Health facilities. This code is billable in combination with rate code 4594 and modifiers “U9” and “UC” as noted in below table.
| Rate Code | Unit Limit per Rate Code | Rate Code Description |
|---|---|---|
| 4594 | 12 units / day | Office Visit |
| Billing Unit Measure: 15 minutes | ||
| Service Description | Modifier | Procedure Code |
| Brief communication technology-based (e.g., virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service or procedure within the next 24 hours or soonest available appointment, 8-10 minutes of medical discussion. Do not report 98016 in conjunction with 98000-98015. Do not report services of less than 8 minutes of medical discussion. This is a patient-initiated service. | U9, SC | 98016 |
Please refer to the links below for more information.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].
Thank you.
MetroPlusHealth
last updated: June 6, 2025