MedicaidReimbursementMedium impact
PT 80-25: Clarification on MCO Payment Responsibility for Health Behavior Assessments Administered in an Acute Care Setting
Maryland Medicaid·MD · Psychiatry, Emergency Medicine, Critical Care·Claims & Billing
Effective date
Jan 1, 2025
We identified it
Jun 18, 2026
Summary
Maryland Medicaid managed care organizations (MCOs) are now responsible for reimbursing health behavior assessments (CPT 96156) performed in acute hospital settings when billed with primary somatic diagnoses. The reimbursement rate is set at $102.83 with no time limits for assessment length.
Action Required
Immediately: Billing teams in Maryland should verify that health behavior assessments (CPT 96156) performed in acute care settings with somatic primary diagnoses are being billed to the appropriate MCO rather than the behavioral health administrative services organization. Update billing system to route these claims correctly and ensure proper place of service codes (11, 12, 21, 22) and qualified provider types are used.