MedicaidBilling CodesHigh impact
Newsletter Vol. 35, No.04
New Jersey Medicaid·NJ · Psychiatry, Emergency Medicine·Coding
Effective date
Mar 3, 2025
We identified it
Jun 20, 2026
Summary
Effective March 3, 2025, MCORT (Mobile Crisis Outreach Response Team) providers in New Jersey must verify Medicaid eligibility for all members receiving mobile crisis services and submit claims using CMS 1500 form with procedure code H2011 and appropriate service modifiers based on provider credential level (HE HO for master's degree, HE HN for bachelor's degree) and service type (initial stabilization or follow-up management). Claims are time-based in 15-minute increments with a maximum of 14 units (3.5 hours) per service date, and separate claims must be submitted for episodes spanning multiple days.
Action Required
By March 3, 2025: Billing team must implement the following changes for all MCORT claims with service dates on or after March 3, 2025: (1) Update billing software to require Medicaid eligibility verification before claim submission; (2) Configure system to use CMS 1500 form for all MCORT claims; (3) Set up procedure code H2011 with required modifier combinations: HE HO (master's degree initial stabilization), HE HN (bachelor's degree initial stabilization), HO TS (master's degree follow-up management), HN TS (bachelor's degree follow-up management); (4) Program system to enforce 15-minute increment billing units with a maximum of 14 units per service date; (5) Configure system to require separate claims for episodes spanning consecutive service days; (6) Train billing staff on the two provided billing scenarios to ensure correct modifier and unit assignment based on highest-level provider on-site and service type. Providers must enroll as home care Medicaid provider with specialty code 893 (Out of Home Crisis Stabilization Services) and provider type 44. Claims submitted without proper eligibility verification, correct modifiers, or exceeding unit maximums will be denied.