MedicaidBilling CodesMedium impact
Provider Letter #A-16: Targeted Case Management Billing
Kentucky Medicaid·KY · Psychiatry·Coding
Effective date
Mar 18, 2021
We identified it
Jun 20, 2026
Summary
Kentucky Medicaid now requires both TG and HF modifiers when billing Targeted Case Management (TCM) for patients with chronic and complex physical health conditions and substance use disorders. This change affects fee-for-service TCM billing for Tier II Behavioral Health Service Organizations.
Action Required
Immediately: Billing team must update TCM claims to include both TG and HF modifiers when billing for patients with chronic/complex physical health conditions and substance use disorders. Update billing system rules to require both modifiers for applicable TCM services. Verify 2021 Behavioral Health and Substance Abuse Services Outpatient Fee schedule reflects these changes.