Coverage of Home Visiting Services for HealthChoice and Medicaid Fee-for-Service Enrollees, Effective January 13, 2022

REQUIREMENTS: - Immediately: Billing team must update billing system to recognize CPT code 99600 for home visiting services with three place of service options: code 4 (home), code 99 (community), and code 12 with GT modifier (telehealth). All three bill at $188 per unit. - Immediately: Configure billing software to enforce one billing unit maximum per calendar week (Sunday-Saturday) per CPT code 99600 to comply with HFA and NFP standards. System must prevent duplicate billing within same calendar week unless documented as crisis exception. - Before processing claims: Verify MCO contracting rates meet or exceed $188 per visit minimum. Update rate tables in billing system if any contracted rates are below this threshold. - Immediately: Update claim submission instructions to clarify that NFP participants must have no previous live births at enrollment, and that prenatal enrollees bill under parent Medicaid ID while postpartum/infant enrollees bill under infant Medicaid ID. - Immediately: For multiple children (e.g., twins) under same caregiver, update billing protocols to allow separate visits billed under each child's individual Medicaid ID. - Before January 13, 2022 (retroactively if not yet implemented): Ensure front desk and providers understand referral sources: MCO providers, physicians, licensed clinicians (social workers, nurse practitioners), or local health departments. Document that no prior authorization is required. - Consequences: Claims submitted outside calendar week billing rules will be denied; rates below $188 may result in underpayment and MCO contract violations; incorrect Medicaid IDs will cause claim rejections.