MedicaidPrior AuthHigh impact
Clarification on Payment Responsibility for Psychological Testing for Medical and Behavioral Health Services
Maryland Medicaid·MD · Psychiatry, Neurology, Bariatric Surgery +1 more·Provider Transmittal
Effective date
Sep 28, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance clarifies payment responsibility for psychological testing between MCOs and BHASO based on primary diagnosis. BHASO covers testing for carved-out behavioral health diagnoses (requires prior auth); MCOs cover testing for non-behavioral diagnoses and pre-surgical psychological evaluations regardless of diagnosis. Billing teams must route claims to the correct payer and verify prior authorization requirements.
Action Required
Effective immediately: (1) Billing team must implement claim routing logic to determine whether psychological testing claims go to BHASO or MCO based on primary diagnosis (verify if diagnosis is a carved-out behavioral health diagnosis in COMAR 10.67.08.02). (2) For CPT codes 96130, 96131, 96136, 96137, 96138, and 96139: obtain BHASO prior authorization when primary diagnosis is behavioral health; route to MCO when primary diagnosis is non-behavioral or for pre-surgical clearance (bariatric surgery, cochlear implants, deep brain stimulation, etc.). (3) For CPT codes 96132 and 96133: route exclusively to MCO (these are neuropsychological codes not covered by BHASO). (4) Update billing system to require prior authorization for all psychological testing codes and include diagnosis-based routing rules. (5) Verify MCO provider networks include contracted psychologists before submitting claims. (6) Train coding and claims staff on the distinction between BHASO vs. MCO responsibility. Failure to route claims correctly or obtain required prior authorization will result in denials.