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01/18/2023
Alliance Rates for BH Services Under the Tailored Plan
In preparation for the Tailored Plan, Alliance will reimburse services provided by physician and physician extenders (nurse practitioners and physician assistants) in accordance with the NC Medicaid Division of Health Benefits fee schedules (Medicaid) with the exceptions outlined below.
Under the Tailored Plan, Alliance will only be able to maintain separate rates for behavioral health services when there is an applicable psychiatric taxonomy to apply in our claims system. Please take note of the changes being implemented.
Physicians
Effective April 1, 2023, Alliance will pay a specific behavioral health rate when one of the taxonomies below is billed on the claim. This applies to only a subset of services as noted on our fee schedule. If another taxonomy is billed, the standard Medicaid physician rate will pay. Please note that if the taxonomy being billed is NOT registered in NCTracks for your provider, the claim will deny.
|
2084A0401X |
Addiction Medicine |
|
2084D0003X |
Diagnostic Neuroimaging |
|
2084F0202X |
Forensic Psychiatry |
|
2084N0008X |
Neuromuscular Medicine |
|
2084N0400X |
Neurology |
|
2084N0402X |
Neurology with Special Qualifications in Child Neurology |
|
2084N0600X |
Clinical Neurophysiology |
|
2084P0005X |
Neurodevelopmental Disabilities |
|
2084P0015X |
Psychosomatic Medicine |
|
2084P0800X |
Psychiatry |
|
2084P0802X |
Addiction Psychiatry |
|
2084P0804X |
Child & Adolescent Psychiatry |
|
2084P0805X |
Geriatric Psychiatry |
|
2084S0012X |
Sleep Medicine |
|
2084V0102X |
Vascular Neurology |
Physician Assistants
Effective April 1, 2023, Alliance will be migrating to the Medicaid physician assistant fee schedule. There is not a separate psychiatric taxonomy for physician assistants. As such, Alliance is unable to maintain specific behavioral rates.
The Medicaid rates posted to the NC DHB website effective April 1, 2023, will be implemented in the Alliance Claims System (ACS). Ongoing updates will follow the NC DHB updates.
Below are examples of rate changes that could impact your organization. Differences in red indicate a lower rate than the current Alliance rate.
|
Facility |
Non-Facility |
Differences |
||||
|
Procedure Code |
CPT Code Description |
Alliance Physician Assistant Rate |
12/13/2022 DHB Rate |
12/13/2022 DHB Rate |
Alliance to Facility |
Alliance to Non-Facility |
|
90785 |
Interactive Complexity |
$ 3.14 |
$ 2.76 |
$ 2.76 |
$ (0.38) |
$ (0.38) |
|
90791 |
Psychiatric Diagnostic Evaluation (No Medical Services) |
$ 119.31 |
$ 68.55 |
$ 87.68 |
$ (50.76) |
$ 31.63) |
|
90792 |
Psychiatric Diagnostic Evaluation (with Medical Services) |
$ 82.50 |
$ 70.82 |
$ 72.75 |
$ (11.68) |
$ (9.75) |
|
99211 |
Established patient office or other outpatient visit, typically 5 minutes |
$ 18.50 |
$ 7.72 |
$ 17.69 |
$ (10.78) |
$ (0.81) |
|
99212 |
Established patient office or other outpatient visit, typically 10 minutes |
$ 36.85 |
$ 21.23 |
$ 36.05 |
$ (15.62) |
$ (0.80) |
|
99217 |
Hospital observation care discharge |
$ 52.12 |
$ 61.02 |
$ 61.02 |
$ 8.90 |
$ 8.90 |
|
99218 |
Hospital observation care typically 30 minutes |
$ 49.16 |
$ 83.52 |
$ 83.52 |
$ 34.36 |
$ 34.36 |
In addition to the changes above, the current COVID rates in place for physician assistants will terminate March 31, 2023.
|
90837 |
Psychotherapy – 53+ Minutes |
|
99213 |
Established patient office or other outpatient visit, typically 15 minutes |
|
99214 |
Established patient office or other outpatient, visit typically 25 minutes |
Nurse Practitioners
Effective April 1, 2023, Alliance will pay a specific behavioral health rate when one of the taxonomies below is billed on the claim. If another taxonomy is billed, the standard Medicaid nurse practitioner rate will pay. Please note that if the taxonomy being billed is NOT registered in NCTracks for your provider, the claim will deny.
|
363LP0808X |
Psychiatric/Mental Health |
|
364S00000X |
Clinical Nurse Specialist |
|
364SP0807X |
Psychiatric/Mental Health; Child & Adolescent |
|
364SP0808X |
Psychiatric/Mental Health
|
|
364SP0809X |
Psychiatric/Mental Health; Adult |
|
364SP0810X |
Psychiatric/Mental Health; Child & Family |
|
364SP0811X |
Psychiatric/Mental Health; Chronically III |
|
364SP0812X |
Psychiatric/Mental Health; Community |
|
364SP0813X |
Psychiatric/Mental Health; Geropsychiatric |
Licensed Psychologist/Licensed Psychological Associate
Alliance currently maintains separate rates for these two clinical levels. As both levels use the same taxonomy, 103T00000X, Alliance will be combining those rates into one rate. Please look for an updated fee schedule coming soon to reflect the April 1, 2023 revised LP/LPA rates.
