Older documents are ARCHIVED on a regular basis.
Reimbursement in the Public Behavioral Health System (PBHS):
The Maryland service class grid provides an overview of the types of services reimbursable for your level of care.
A fee schedule is a complete listing of service codes and fees used to pay services within the PBHS system. Beacon has provided a listing of Mental Health, Substance Use Disorder and other specific levels of care by fee schedules for providers to use. For previous fee schedules, please see the archive page.
- Medicaid Behavioral Health CY 2016 (PDF)
- PBHS Reimbursement
- PBHS Reimbursement Schedule (Eff. 07-01-18) (PDF)
- SUD Fee Schedule (Eff. 07-01-18) (PDF)
- SUD Fee Schedule (Eff. 09-01-17) (PDF)
- SUD Matrix (Eff. 05-15-17) (PDF)
- FQHC Fee Schedule (Eff. 07-01-17) (PDF)
- 1915i Fee Schedule (Eff. 07-01-18) (PDF)
- Maryland Recovery Network (MDRN) Fee Schedule Eff. 10-1-16 (PDF)
- 8-507/PWC Grant Program Fee Schedule
- Gambling Fee Schedule (Eff. 1-1-18)
- 8-507/PWC Grant Program Fee Schedule (PDF)
- Grant-based Fee Schedule (PDF)
- PBHS PRP Billing Cascade (Eff. 07-01-18) (PDF)
- PBHS PRP Billing Cascade (Eff. 07-01-17) (PDF)
- PBHS PRP Billing Cascade (Eff. 07-01-16) (PDF)
- Health Home Fee Schedule (Eff. 07-01-17) (PDF)
- Important Claims Documents
- Combination of MH Services 1.30.13 (PDF)
- Combination of SUD Services (Effective 07-01-17) (PDF)
The combination of services rules provide an outline of the types of services that may be provided to an individual within the same day, week or course of treatment. These rules outline the interventions that may be implemented in combination and involve the use of two or more coordinated interventions by the same or differing providers.
Frequently Asked Questions — FAQs
SUD OMS Discharge
(PT-54) Adult Residential Treatment - 3.1 (Coming Soon Eff. 1.1.19)
(PT-54) Adult Residential Treatment
(PT-54) 8-507, PWC, SB512, HB7 Adult Residential Treatment
- PBHS Diagnoses (Effective 01-01-15) (PDF)
- ICD-10 Mental Health Diagnosis (Effective 10-01-15) (PDF)
- ICD-10 Substance Use Disorder Diagnosis (Effective 10-01-15) (PDF)
- Poison Diagnosis ICD-10 (Eff. 4-1-16) (PDF)
- ICD-10 Gambling Diagnosis (Effective 01-01-18) (PDF)
- Priority Population Diagnosis – July 08, 2014 (PDF)
The Maryland Public Behavioral Health System (PBHS) is committed to facilitating the participant’s recovery through treatment and rehabilitation services that are in the least restrictive and intensive level of care necessary to provide safe and effective treatment and meet the participant’s biopsychosocial needs. The continuum of care is a fluid treatment pathway, where participants may enter treatment at any level and receive services, in more or less intensive settings or levels of care, as their changing clinical needs dictate. Beacon Health Options, Inc. (Beacon) will implement this philosophy while facilitating participant choice in the treatment process.
For more information regarding covered diagnoses and priority population, please see the below. The diagnosis are also listed in COMAR 10.09.70
Beacon authorizes services for the Public Behavioral Health System. Below are a few examples of specialized services that are available for Maryland individuals that meet the Medical Necessity Criteria (MNC). If you would like more information regarding all covered services, please review our Provider Manual for full description and MNC.
Intensive Case Management Program
It is the policy of Beacon Health Options (Beacon) to offer members with complex and high risk behavioral /medical conditions the enhanced services of an Intensive Case Management (ICM) program. This program is available to all Beacon members as a value-added service, contingent on available program resources. It does not replace or conflict with the Medicaid approved service of Targeted Case Management. Criteria that must be met to be eligible for intensive case management include, but are not limited to, multiple hospitalizations within the past year and/or a co-morbid medical diagnosis.
To refer a member to ICM, please call 800-888-1965 ext. 214030 for more information.
The Maryland Public Behavioral Health System (PBHS) emphasizes communication between mental health providers, medical care providers, and substance related disorder providers. Beacon Health Options, Inc. (Beacon) has embraced this integrated philosophy and provides key services that will enable better coordination of care for an individual’s treatment teams. With the consent of the individual through a completion of a release of information (ROI) form, the treating behavioral health provider(s) communicate directly with the medical care provider on a regular basis in order to coordinate behavioral health and somatic health care. Interdisciplinary and interdepartmental conference calls, data sharing, treatment planning, and outreach to participants are all options for coordinating care on high-risk participants. To assist in this coordination of care, Beacon also communicates with the HealthChoice Managed Care Organizations (MCOs), the Maryland Department of Health and local stakeholders regarding high-risk participants with co-occurring behavioral health conditions and medical disorders.
- For additional information regarding how to enroll an individual please see the below referral forms:
- Procedure for TCM/ 1915(i) Referrals
- TCM/1915(i) Referral Form
- For additional information on enrolling as a provider, please see the below enrollment applications:
The 1915(i) services are intensive behavioral health services for children, youth, and families and builds upon the prior 1915(c) RTC waiver that allowed states to provide home and community-based care to participant’s that would otherwise be institutionalized. Included in the 1915(i) program are an array of diagnostic and therapeutic mental health services, including 24-hour availability of mental health and/or crisis services, which are provided to the child or adolescent and family using a wraparound approach that includes intensive care coordination with an individualized plan of care. Specialized services not otherwise available through the Medicaid program include mobile crisis stabilization, respite services, intensive in home services, expressive and experiential behavioral services, and family and peer support services.
Beacon also reviews and works in collaboration with Maryland hospitals to discuss their average lengths of stay for inpatient mental health services. For more information regarding how your hospital or local area hospitals compare, you may review monthly reports at:
- COMAR Regulations
- Provider Audits
- Policies & Procedures
- BHA Policy and Procedure for Inpatient Retroactive Chart Review within the Public Behavioral Health System
- Provider Audit Information Under Construction
- Record Attestation (Effective August 1, 2015)
- Policies & Procedures
- Audit Tools
DHMH has approved the following audit tools and definitions for scoring quality of documentation items. Depending upon the license of the program being audited, one of these tools will be used.
- SUD Level 1 – Outpatient
- SUD Level 2.1 Intensive Outpatient (IOP)
- PT 32 – Opioid Treatment Program
- Outpatient Mental Health Clinic (OMHC)
- CPT E-M Codes (Established Patient)
- Individual and Group Practices
- Audit Tools
- Psychiatric Rehabilitation Program (PRP Adult)
- Psychiatric Rehabilitation Program (PRP Minor)
- Residential Treatment Center
- Inpatient Facilities
- Therapeutic Behavioral Services (TBS)
- Intensive Outpatient (IOP)
- Partial Hospitalization Program (PHP)
- Mobile Treatment
- MPBHS Participant Perception of Care Survey - 2017
- MPBHS Provider Survey - 2013