New Behavioral Health Day Treatment Benefit

By October 1, 2026: (1) Billing team must update billing software to use HCPCS code H2012 with new modifiers for behavioral health day treatment claims submitted on or after this date. (2) Providers must obtain prior authorization for ALL behavioral health day treatment services using the new Prior Authorization/Behavioral Health Day Treatment Attachment form (F-03454, 10/2026), except for the first 8 assessment hours in a rolling 12-month period which do not require PA. (3) When submitting PA requests, providers must include complete supporting clinical documentation: for SUD-only services include bio-psychosocial assessment, ASAM level of care determination, treatment plan, and continuing care plan; for mental health-only include mental health assessment, treatment plan, and continuing care plan; for co-occurring include bio-psychosocial assessment, mental health assessment, ASAM level of care determination, treatment plan, and continuing care plan. PA requests without complete documentation will be denied without clinical review. (4) Update all encounter forms and templates to reflect the new benefit structure and expanded youth coverage (with separate services required for transitional-age youth ages 16-24). (5) Administrative staff should note that existing Medicaid-enrolled substance abuse day treatment providers do NOT need to re-enroll; their specialty will automatically update to 803. Claims submitted without proper modifiers, prior authorization, or complete documentation will be denied.