MassHealth: Adjustment to Medicare Crossover Claims

June 2017 ~

MassHealth has adjusted Medicare Crossover claims with dates of service on and after 01/01/2015 through adjudication date 03/23/2017 that were billed with procedure CPT codes 90847 or 90853.

These Crossover claims (previously paid the Medicare patient responsibility) have been adjusted to pay the lesser of the MassHealth allowed amount minus the Medicare payment or the patient responsibility per All Provider Regulations CMR: 450.318 (c). These adjusted claims will appear on future remittance advices formal notice of a financial transaction and Crossover claims adjudicated on or after 03/24/2017 are adjudicating and pricing correctly.

MassHealth reminds Mental Health Centers that as of July 2013, CMS established a one unit limit on three behavioral health codes where MassHealth allowed up to four units (90847-family therapy, 90849-multiple family group therapy and 90853-group therapy). In October 2013, CMS established a one unit limit on one behavioral health code where MassHealth allowed up to four units (90882-Environmental intervention for medical management).

MassHealth initiated an increase to the rate for one unit for each code. Mental Health Center regulations were promulgated in March of 2014 to increase the rates with a 01/01/2014 effective date. On 09/01/2015 the revision was made retroactively to 07/1/2013 for codes 90847, 90849 and 90853 and to 10/01/2013 for code 90882.

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Source(s): MassHealth;