MedicaidBilling CodesHigh impact
Claims and Encounter Submissions
Maryland Medicaid·MD · Dentistry, Psychiatry, Family Medicine +3 more·Provider Transmittal
Effective date
Mar 21, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has clarified claims and encounter submission requirements for FQHCs and RHCs, including proper billing procedures for somatic, behavioral health, dental, and LARC services. Key requirements include billing behavioral health and SUD services through ASOs (Optum Maryland and SKYGEN USA), using specific procedure codes (T1015 for behavioral health, D0999 for dental), and proper handling of services rendered in hospital settings on professional claims only.
Action Required
Effective immediately, billing team must: (1) Update billing workflows to route behavioral health and SUD services to Optum Maryland ASO and dental services to SKYGEN USA ASO, regardless of MCO or FFS enrollment; (2) Implement use of CPT code T1015 for all behavioral health claims and telehealth behavioral health using appropriate procedure codes from Fee-for-Service Trigger Code list; (3) Implement use of CDT code D0999 for dental claims with individual services marked at $0.00 charge; (4) Configure system to accept LARC procedure codes J7296, J7297, J7298, J7300, J7301, J7307 for reimbursement at Professional Services Fee Schedule rates; (5) Ensure Medicare secondary claims using T1015 have charges matching EOMB amounts on CMS-1500 forms or claims will be rejected; (6) Prohibit billing hospital-based services using FQHC/RHC Maryland Medicaid NPI—require rendering provider's individual or physician group NPI on professional claims (CMS-1500) instead. Providers must validate somatic service codes against HealthChoice Encounter Data Trigger Code and Fee-for-Service Trigger Code lists. Failure to comply will result in claim denials and ASO routing errors.