MedicaidAdministrativeMedium impact
Billing Clarification about Somatic Conditions Related to Carved-Out Behavioral Health Diagnoses
Maryland Medicaid·MD · Emergency Medicine, Internal Medicine, Gastroenterology +1 more·Provider Transmittal
Effective date
Jan 19, 2024
We identified it
Jun 20, 2026
Summary
Maryland clarifies billing rules for somatic conditions related to behavioral health diagnoses: medical treatment of physical symptoms (like vomiting from cannabinoid hyperemesis syndrome) should be billed to MCOs with somatic primary diagnosis codes, not to Behavioral Health ASO, regardless of substance use connection.
Action Required
Immediately: Maryland hospital billing teams must ensure somatic conditions related to substance use (like vomiting from cannabinoid hyperemesis syndrome) are billed to MCOs with somatic primary diagnosis codes (e.g., R11 for vomiting), not to BHASO. Review current claims for substance-related medical symptoms and redirect to appropriate payer. Before disputing claims, first appeal with initial payer (MCO or ASO) and include appeal results with any DRC review requests.