July 24, 2026

Provider Notice: Behavioral Health Billing Update

WellCare received notification from the Kentucky Department for Medicaid Services (DMS) on July 2, 2026, regarding the following billing requirements, effective retroactively to January 1, 2024.

Residential/Inpatient Behavioral Health Services

Tier 3 Behavioral Health Service Organizations (BHSOs) (Provider Type 03) licensed to provide residential substance use disorder (SUD) treatment may bill Kentucky Medicaid for the following residential/inpatient per diem codes:

H0011, H2034, H2036, S9485

Prohibited Same-Day Billing

A BHSO (Provider Type 03), or any other Kentucky Medicaid provider, may not bill the following outpatient or ancillary behavioral health service codes for the same member on the same date of service as any of the residential/inpatient codes listed above.

Psychotherapy and Counseling Codes

90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853

Behavioral Health Intervention/Support Codes

H0004, H0015, H0025, H0035, H0038, H0038 HQ, H2012, H2015, H2019, H2020, H2027, H2027 HQ, S9480, T1007

Claims submitted for the same member and date of service that include both a residential/inpatient per diem code and any of the prohibited outpatient or ancillary behavioral health service codes will be considered duplicative and will be denied.