MedicaidReimbursementMedium impact
Payment of Medically Necessary Ancillaries on an Administrative Day: MWPH
Maryland Medicaid·MD · Pediatrics, Critical Care·Special Pediatric Hospital
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance Program implemented a new billing policy for Mount Washington Pediatric Hospital (MWPH) allowing reimbursement for Administrative Days with medically necessary ancillary services when patients no longer meet acute care level of service. MWPH must request Administrative Days through the Utilization Control Agent with documentation showing placement activity occurred at least 3 days per week, and must select either an Administrative Day without Respiratory Care ($826) or with Respiratory Care ($2,360).
Action Required
By July 1, 2024 (immediate): MWPH billing team must implement the following: (1) Update billing system to recognize two Administrative Day billing options (Option 1: revenue code 0169 at $826; Option 2: revenue codes 0169 + 0410 at $2,360 combined) and enforce mutual exclusivity (cannot bill both on same day); (2) Obtain and complete the updated MDH 1288-MWPH form for all Administrative Day requests, documenting placement activity conducted minimum 3 days per week and identifying specific medically necessary ancillaries provided; (3) Submit completed 1288-MWPH form and supporting documentation to the Utilization Control Agent for retrospective review approval; (4) Ensure providers and clinical staff document all medically necessary ancillary services delivered on Administrative Days (will be audited in 6-12 months); (5) Apply HSCRC discount to actual payments when received. Failure to follow these procedures will result in claim denials and payment delays. This policy applies to Maryland Medical Assistance Program Fee-For-Service participants at MWPH only.