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Effective for claims with dates of service on and after January 1, 2024, the Health Care Authority (HCA) will implement legislatively mandated rate increases for developmental and behavioral health screening authorized in the 2023-25 state operating budget.
Effective for claims with dates of service on and after January 1, 2024, HCA will also begin requiring the use of a modifier when submitting claims to indicate whether a need was identified during the developmental and behavioral health screening. HCA will revise the appropriate billing guides to reflect this new policy.
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- Qualified Apple Health providers defined in the EPSDT Well-Child Program
- Planned home births and births in birthing centers
- Mental health services
- Users of the physician-related services and professional health care services billing guide
Which codes are impacted?
These changes apply to the following CPT® screening codes:
CPT is copyright © 2022 American Medical Association. All rights reserved.
What is the new billing guidance?
Providers must include one of the following modifiers when billing any of the screening codes above to indicate whether a need was identified.
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Modifier
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Description
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U1
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No need identified (negative screen). Indicates screening score within a normal range.
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U2
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Need identified (positive screen). Indicates risk, concern, impairment, or identification of a developmental and/or behavioral disorder.
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See the "What has changed" table in the appropriate billing guide for more details about these policies and additional updates.
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