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A 3.2% inflationary effect has been applied to Behavioral Health Medicaid State Plan services reimbursement rates for State Fiscal Year (SFY) 2025, impacting the following provider fee schedules:
- CBHS and MHPC State Plan services
- Independent Psychologist+
- Independent LCSW
- Independent LMFT
- Independent LPC
- Autism
+The following services on the Independent Psychologist fee schedule are not subject to a flat inflationary increase and are still pending confirmation of SFY2025 rates: 96105, 96110, 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96146.
This rate increase is effective for all dates of service (DOS) beginning July 1, 2024, through June 30, 2025.
SFY2025 provider fee schedules will be published to the Division of Behavioral Health (DBH) Medicaid Related Information webpage as soon as possible.
DBH is working closely with our Optum partners to implement timely configuration of these rate changes, with a go-live date to be confirmed once work order scoping has completed. While configuration is pending, claims submitted with DOS on or after July 1, 2024, will be reimbursed at the SFY2024 Medicaid allowable reimbursement rate. Once configuration and testing is complete, DBH and Optum will reprocess eligible claims for payment at the new rates.
Eligible claims for automated reprocessing are those that are billed to Optum at or above the SFY2025 maximum allowed Medicaid reimbursement rate. Claims billed by providers at the existing SFY2024 rates will require provider-initiated adjustment requests to pay up to the SFY2025 maximum. Once fee schedules are posted, agencies should coordinate timely delivery of new rates to their billing resources to avoid delay in processing claims up to their full Medicaid allowance.
DBH provider fee schedules do not include reference to all services reimbursed by Medicaid. If there are questions about services in this chart or services not covered in this chart, controlling regulation should be consulted. Regulatory payment restrictions such as payment limits, coverage limitations, mutually exclusive restrictions, or service authorization requirements are not fully addressed in the fee schedule documents.
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