MedicaidReimbursementMedium impact
Primary Care Investment: E&M Increases Technical Update
Maryland Medicaid·MD · Psychiatry·Managed Care Organizations
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Maryland's Medicaid MCOs are expanding increased E&M reimbursement rates to include Nurse Psychotherapists (APRN-PMHs with Psychiatric Mental Health Certification) alongside psychiatrists and psychiatric nurse practitioners. This technical update to PT 88-25 clarifies that all three behavioral health provider types are eligible for the enhanced rate effective August 1, 2025, regardless of practice setting.
Action Required
By August 1, 2025: Billing team must verify that claims for Nurse Psychotherapists (PT 24, APRN-PMH) with Psychiatric Mental Health Certification are being submitted with the increased E&M rates. Update billing system fee schedules and credentialing records to reflect that PT 24 providers now qualify for the enhanced reimbursement. Ensure encounter forms and billing validation rules recognize Nurse Psychotherapists as eligible for increased rates. Confirm with MCOs which specific rate tables apply. Failure to update rates may result in underbilling and lost revenue. Contact MCOs directly at mdh.pcmodel@maryland.gov if rate schedules are unclear.