General Provider Communication

Subject: Place of Service 11 (Nursing Codes) and Encounters Pend Code S430

Action: Please review carefully to ensure you are using the correct codes.

 

Dear Provider,

 

Per the communication from ADHS below, Magellan has been notified, retroactive to 9/30/13, that place of service (POS) code 11 (Office) is no longer valid for behavioral health clinics and that POS 53 (Community Mental Health Center) should be used for services provided in the clinic.

 

Claims already paid as of 10/1/13 with POS 11 will be adjusted to pay with POS 53 by Magellan.  Please refer to the communication below for specific code updates and refer to the Covered Service Guide B-2 matrix for allowable POS codes for all procedure codes used at your agency.

 

We will be sending a file to your agency of the claims that need to be adjusted and will do so upon your approval in writing (an e-mail response is sufficient).

 

Please note, as of 12/20/13, claims received by Magellan with POS 11 for provider type 77 will be denied for invalid place of service code and will need to be resubmitted with POS 53 or other allowable POS code. This is not date of service-specific, but includes all dates of service submitted as of 12/20/13.

 

Information from ADHS regarding Place of Service 11 (nursing codes) and Encounters Pend Code S430:

 

After consideration, AHCCCS agrees to the following changes:

  • POS 53 (Community Mental Health Center) will be added to include codes J2794, T1002, and T1003 effective 10/01/13
  • POS 53 will be added to include codes 97810, 97811,97813, and 97814 for the Non-Title XIX effective 10/01/13
  • POS 99 will be closed (end dated) for codes J2794, T1002 and T1003 effective 09/31/13
  • ADHS/DBHS will submit an override request to AHCCCS for those encounters that are currently pending POS 11 (office) encounters for codes J2794, T1002, and T1003.  AHCCCs will work in partnership with ADHS/DBHS to override these codes to resolve the encounter pends.

Additionally:

  • The approved codes are to be used only by the Regional Behavioral Health Authorities (RBHAS) and are not intended for physical health.
  • Should a nurse provide services on the same day as a higher level of service (e.g., services by a psychiatrist or other physician), the nursing service will be considered inclusive of the higher level of service.
  • The codes are to be billed for visits between appointments with the psychiatrist only.
  • AHCCCS will audit the use of these codes moving forward and will recoup as determined appropriate. 

 

AHCCCS will not be approving the addition of any other codes for POS 11.

 

Please note that any encounters previously voided by the RBHA's will need to be resubmitted with POS 53.

 

Thank you.

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