How Do I Bill for
Services Related to Behavior Disorders?
A behavior assessment is part of each EPSDT Care for Kids screening. To bill for the periodic screening, use the HCFA 1500 form, with the procedure code W0051, or preventive office visit codes, and the appropriate modifier. If problems are suspected or found, and further evaluation and management are needed, or if the problem is evaluated between periodic screens, use the appropriate CPT billing codes for evaluation and management of new or established patients (99201-99205 or 99211-99215).
If the diagnosis requires mental health services, these are managed by MBC of Iowa under the Mental Health Access Plan (MHAP). However, not all Medicaid clients are enrolled in MHAP. Persons who are enrolled in MHAP have a Medicaid card imprinted with the following words: "For mental health services, call (800) 955-6472." If this statement does not appear, please call:
Recipient Eligibility Verification System (REVS)
800-735-6704 or 515-825-4660.
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