Audio-only behavioral health service codes

Having trouble viewing this email? View it as a Web page.

Health Care Authority (HCA) logo

Audio-only behavioral health service codes

This message is intended as follow-up to the April 1, 2022 HCA Issue #29453 regarding HCA publishing audio-only telemedicine billing codes. This guidance specifically applies to behavioral health service codes within the Service Encounter Reporting Instructions (SERI) Guide, the fee-for-service Mental Health Billing Guide (part II) and Substance Use Disorder Billing Guide.

What is happening?

Effective August 1, 2022, the Health Care Authority (HCA) will allow for audio-only services for specific billing codes when provided and billed as directed in HCA's provider billing guides. Approved behavioral health service codes are posted on HCA’s Provider billing guides and fee schedules webpage under the telehealth tab.

These codes need to be accompanied with the FQ audio-only modifier, within the Service Encounter Reporting Instructions (SERI) Guide, the fee-for-service Mental Health Billing Guide (part II) and Substance Use Disorder Billing Guide.

Note: Current Apple Health (Medicaid) policies require utilization of the appropriate audio-only modifiers (93 or FQ).  Information related to specific service areas and billing guidelines includes the following:

  • For SERI, Part II of the Mental Health Billing Guide and the Substance Use Disorder Billing Guide, providers will use modifier FQ
  • For Part 1 of the Mental Health Billing Guide, providers will use modifier 93
  • All other programs will use modifier 93

Policy and current guidance

In order to allow for Medicaid reimbursement HCA is tasked with implementing access to audio-only services as directed, in consideration of the CMS requirement to ensure “safe & effective care”, as well as recent legislation House Bill 1196 and House Bill 1821. This legislation requires clients or patients to be established before allowing audio only services.  Therefore, future policy will require that some specific service modalities be conducted either in person or via HIPAA compliant audio-visual.

HCA is finalizing accompanying policies and updated billing & encountering guidance.

Regarding the public health emergency and guidance

While the public health emergency is still in effect, the following Behavioral Health FAQ is still valid:

Note: As of August 1 2022, the behavioral health audio only codes outlined in the list above will be the only behavioral health codes approved for rendering audio only services. The Service Encounter Reporting Instructions (SERI) Guide instructions are in section I, the fee-for-service Mental Health Billing Guide (part II) and Substance Use Disorder Billing guide is in section II, and the fee-for-service Mental Health Billing Guide (part I) is in section III.

Online resources

HCA publishes updates to online resources on our Provider billing guides and fee schedules webpage.