Important Billing Notice to Behavioral Health Providers: Mental Health Targeted Case Management (MHTCM) Required Procedure Code

Date: 05/16/22

Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and STAR+PLUS Medicare-Medicaid Plan (MMP) behavioral health providers delivering Mental Health Targeted Case Management (MHTCM) services must use procedure code T1017, and the following modifiers, for services are billed appropriately.

Modifier	Modifier Description	Modifier Position	Eligible Population
TF	Routine Case Management	Primary	Children/Adolescents/Adults
TG	Intensive Case Management	Primary	Children/Adolescents
HA	Child/Adolescent Program	Secondary	Child/Adolescents

As a reminder, Intensive Case Management and Routine Case Management are benefits for child/adolescent members who are 20 years of age and younger. These services cannot be billed for the same service date.

Routine Case Management is a benefit for adult members who are 21 years of age and older.

To ensure timely and appropriate reimbursement, placement of the appropriate modifier TF or TG on claims must be in the first modifier position. Reimbursement for procedure code T1017 is limited to select diagnosis codes. For a detailed list of these codes, please refer to the Behavioral Health and Case Management Services Handbook.

Please note that modifier HZ (Funded by criminal justice agency) can also be used with procedure code T1017; however, if it is billed to Superior HealthPlan, the claim will be denied. Providers must bill using the appropriate modifier listed in the table above to be reimbursed by Superior.

For any questions, please contact the Behavioral Health Account Management Team at AM.BH@superiorhealthplan.com.