As you may be aware, Neighborhood Health Plan (NHP) requires that Primary Care Providers (PCPs) offer periodic and medically necessary inter-periodic screens to members under the age of 21 in accordance with the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and Preventive Pediatric Healthcare Screening and Diagnosis (PPHSD) Periodicity Schedules. This requirement applies to MassHealth members only. However, to minimize administrative complexities and in our continuous quality improvement efforts, NHP covers this service for all members.
NHP reimburses one (1) screening per member per day, regardless of the number of screening tools administered for a member on a single day.
To be eligible for reimbursement, Primary Care Providers (MDs and NPs) must use specific, clinically appropriate behavioral health screening tools accommodating different age ranges while allowing some flexibility for provider preference and clinical judgment. Additionally, procedure code 96110 must be billed with the appropriate U modifiers (U1 - U8) indicating the type of provider who conducted the screening and whether a behavioral health need was identified.
Effective for services rendered on or after July 1, 2011 claims submitted without the corresponding U modifier are subject to deny.
Please share this important change with billing and other staff as you deem appropriate. Additional information on this requirement is available within the Billing section of our Provider Manual.
