New Rate (Rate Code) and Other Billing Codes Combination for Health Home Plus and Assisted Outpatient Treatment (AOT)
TO: Health Homes Providers
IMPACTED PLANS: Medicaid, HIV SNP, and HARP
DOH has released guidelines for providers to use the new Medicaid rate code (1876) in combination with the revenue, procedure, and modifier codes for Health Home Plus/Assisted Outpatient Treatment (AOT) order for dates of service effective April 1, 2024 and onwards.
MetroPlusHealth has configured their systems to process and pay claims billed with the following codes listed in the table below:
| Rate Code | Revenue Code | Procedure Code | Modifier |
|---|---|---|---|
| 1876 | 0500 | G9005 | U6 |
Note: In addition, MetroPlusHealth will also reprocess payment adjustments for Health Home Plus Care Management previously paid claims billed with rate code 1853, procedure code G9005, modifier U4 Health Home members on AOT order with dates of service on or after April 1, 2024.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].