MedicaidBilling CodesHigh impact
MOM Case Management Services Code for Submitting Managed Care Encounters, Effective January 1, 2024
Maryland Medicaid·MD · Family Medicine, Internal Medicine, OB-GYN +2 more·Provider Transmittal
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Effective January 1, 2024, Maryland MCOs must submit encounters using code MC050 for MOM Case Management Services on a per-member-per-month (PMPM) basis at $208 per month. MCOs must use a modified NPI (9-digit Medicaid ID with '5' prefix) and may submit one encounter per month per enrolled participant, with pregnancy- or OUD-related diagnosis codes required.
Action Required
By December 31, 2023: Billing team must update billing system to recognize and process MC050 encounter code for MOM Case Management Services. Configure system to: (1) calculate and submit $208 PMPM for each actively enrolled MOM participant, (2) enforce one-encounter-per-month limit per participant and void duplicates, (3) require NPI format as 5-digit prefix + 9-digit Medicaid provider ID (5XXXXXXXXX) for both billing and rendering provider fields, (4) apply appropriate diagnosis codes (F11.20, F11.10, O26.90, or Z34.80) based on member status. Train billing staff on new encounter submission process. Ensure monthly Care Delivery Partner and Outreach Attempt Log reports continue to be submitted separately. Failure to implement will result in claim rejections and payment delays for MOM case management services.