MedicaidCoverageHigh impact
Medicaid Coverage of Peer Recovery Support Services in Licensed Community-Based SUD Programs
Maryland Medicaid·MD · Psychiatry·Provider Transmittal
Effective date
Jun 1, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now covers peer recovery support services provided by Certified Peer Recovery Specialists (CPRS) in licensed SUD and opioid treatment programs effective June 1, 2023. Billing teams must enroll providers, add two new HCPCS codes (H0038 and H0024) to their systems, and ensure compliance with CPRS certification and supervision requirements by September 1, 2023.
Action Required
REQUIREMENTS:
- By August 31, 2023 (DEADLINE): Providers must complete supplemental ePREP applications including CPRS certifications, peer supervisor credentials, and background check results. Non-RPS supervisors may serve temporarily through this date only.
- By September 1, 2023: All peer supervisors must be Registered Peer Supervisors (RPS) certified by MABPCB. Providers with non-RPS supervisors must submit new supplemental applications documenting RPS compliance. Claims will be denied if supervision requirements are not met.
- Immediately: Billing team must add H0038 (Individual Peer Recovery Support Service, 15-min unit, $16.38 rate) and H0024 (Group Peer Recovery Support Service, 15-min unit, $4.55 rate) to billing system and fee schedules for Maryland Medicaid only.
- Before June 1, 2023 (retroactive - immediate action): Update billing system to recognize these codes for Medicaid Provider Types 32 (OTPs) and 50 (SUD programs ASAM Levels 1, 2.1, 2.5). Configure encounter forms and billing workflows to capture 15-minute units of service.
- Ongoing: Billing team must verify provider enrollment status in ePREP before submitting claims. Only providers with approved supplemental/new applications are eligible for reimbursement. Route all enrollment questions to mdh.mabehavioralhealth@maryland.gov.