Provider Enrollment & Billing Guidance for BH Peer Support Service

On June 14, Ohio Department of Medicaid filed administrative code rule 5160-27-14 ‘Behavioral health peer support service’ that expands Ohio Medicaid behavioral health coverage of peer support service to include Medicaid enrollees being treated for mental health conditions and continues current coverage for SUD. The department anticipates the rule will become effective September 1, 2024.

How providers can prepare for the service
In support of expanding peer support services to treat mental health conditions the Ohio Medicaid Behavioral Health Provider Manual will be updated to align with the rule’s effective date.

Beginning immediately, community behavioral health agencies enrolled as providers of mental health treatment (provider type 84) may begin affiliating their certified peer support staff for a September 1 start date.

Please note, if an employing community behavioral health agency is enrolled with Medicaid as both an 84 (community mental health agency) and a 95 (community substance use disorder treatment agency), the peer MUST be affiliated with BOTH agencies’ provider types to render and bill for services for both mental health and SUD peer support care.

More information regarding Ohio Medicaid Provider Enrollment check-out the resources below:

Mental health peer support claims and reimbursement

Coverage for mental health peer support services billed by community mental health agencies (provider type 84) will begin for dates of service on or after the effective date of OAC rule 5160-27-14 (anticipated September 1). There is no change in the billing codes used for behavioral health peer support (H0038 and H0038 HQ) or for the payment rate listed in the Medicaid Behavioral Health Provider manual. More details are available in the presentation ODM and MHAS previously shared on these changes.

If you have any questions about Medicaid behavioral health program or this notice, please direct them to [email protected].