Updates to the ECM and Community Supports Healthcare Common Procedure Coding System (HCPCS) Coding Guidance
| Date: | March 13, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Enhanced Care Management (ECM) and Community Supports Providers |
| Type: | Regulatory |
| Subject: | Updates to the ECM and Community Supports Healthcare Common Procedure Coding System (HCPCS) Coding Guidance |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) recently updated the Community Supports HCPCS Coding Guidance in January 2024. The updated HCPCS Coding Guidance can be found here: https://www.dhcs.ca.gov/Documents/MCQMD/Coding-Options-for-ECM-and-Community-Supports.pdf
These updates are labeled throughout the HCPCS Coding Guidance and summarized in the Appendix. DHCS will periodically make updates to this guidance moving forward. ECM and Community Supports Providers are expected to implement and adhere to the updates in this guidance by March 31, 2024.
Below is a summary of the substantive edits DHCS made:
ECM Coding Options
- Defined clinical and non-clinical staff and clarification on the purpose of the distinction.
- Clarified that ECM Outreach codes can be used for both successful and unsuccessful outreach attempts.
- Included a new HCPCS code, G9007, to capture ECM multidisciplinary team conferencing when a member is not present.
Community Supports Coding Options
- Added clarifying guidance about how to bill using the 15-minute time increment when the service is less than 15 minutes.
- Added assisted living services to the code description and corrected the modifier description in H2022, U5 modifier to indicate that the services are for Nursing Facility Transition/Diversion to an Assisted Living Facility.
- Indicated the effective start dates for per diem codes/modifiers that were added after 1/1/2022.
- Housing Tenancy and Sustaining Services, Financial Management, T2050, U6 modifier.
- Housing Tenancy and Sustaining Services, Support Brokerage, T2051, U6 modifier.
- Short-Term Post-Hospitalization Housing, Supported Housing, H0043, U3 modifier.
- Day Habilitation Programs, Skills Training and Development, H2038, U6 modifier.
Coding Guidance – Outreach for Initiation of Housing Transition and Navigation, Housing Deposits, and Housing Tenancy and Sustaining Community Support Services
- New required HCPCS code and modifier combinations (T1016, U8 modifier; T1016, U8 modifier, GQ modifier) were added to capture outreach efforts to members for the initiation of Housing Transition and Navigation, Housing Deposits, and Housing Tenancy and Sustaining Community Supports services.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG