MedicaidAdministrativeMedium impact
OMHSAS-16-07 Bulletin
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics·Provider Bulletin
Effective date
Jun 6, 2016
We identified it
Jun 20, 2026
Summary
Entities without outpatient, partial hospitalization, or family-based mental health licenses can now enroll in Pennsylvania's Medical Assistance program to provide Applied Behavioral Analysis (ABA) services to children with autism using specific BSC-ASD and TSS services. New specialty types and billing codes with modifiers have been established for these unlicensed entities.
Action Required
Immediately: Billing teams for entities providing ABA services to children with autism in Pennsylvania must complete Provider Type 11 enrollment application with Specialty Type 561 (BSC-ASD) and/or 562 (TSS) if unlicensed. Submit service descriptions for approval before billing. Use H0046 with HP+HA modifier for psychologist BSC-ASD services, H0046 with HO+HA modifier for other licensed BSC-ASD providers, and H2021 with UB+HA modifier for TSS services. Update billing systems with new fee schedule rates: $15.75 per quarter hour for psychologist BSC-ASD, $12.25 per quarter hour for other BSC-ASD providers, and $15.00 per half hour for TSS services.