MedicaidCoverageMedium impact
Clarification of Policy for Coverage of Behavioral Health Ancillary Services at Special Pediatric Hospitals
Maryland Medicaid·MD · Pediatrics, Psychiatry·Provider Transmittal
Effective date
Aug 23, 2023
We identified it
Jun 20, 2026
Summary
This policy clarifies billing and payment responsibility for behavioral health ancillary services at special pediatric hospitals in Maryland. When a pediatric patient is admitted with a primary somatic diagnosis, MCOs cover the entire inpatient claim including behavioral health ancillaries (090x and 091x revenue codes). When the primary diagnosis is behavioral health, the Behavioral Health Administrative Services Organization reimburses professional fees for specialty mental health practitioners billing on CMS-1500 forms.
Action Required
By September 23, 2023: Billing team must implement the following changes at special pediatric hospitals in Maryland: (1) Configure billing system to properly route inpatient claims based on primary diagnosis—somatic primary diagnoses route to MCOs for full claim payment including behavioral health ancillaries (090x and 091x revenue codes), while behavioral health primary diagnoses route ancillary professional fees to the Behavioral Health Administrative Services Organization; (2) Ensure MCO billing systems are updated to accept and process behavioral health treatment/services revenue codes 090x and 091x series for special pediatric hospitals; (3) Train specialty mental health practitioners to bill professional fees on CMS-1500 forms using primary behavioral health diagnoses per COMAR 10.67.08.02 when applicable; (4) Update claim routing logic to direct behavioral health professional fees to the correct payer. Incorrect routing will result in claim denials and payment delays. Contact Aran Kim at aran.kim@maryland.gov for policy clarification.