HCPCS Code T1040: Medicaid-Certified Community Behavioral Health Clinic Services, Per Diem

## **Documentation requirements for T1040** As with any HCPCS code, you'll need to provide sufficient documentation before filing for a claim. In the context of this code, you'll need to familiarize yourself with coding requirements and guidelines set for Medicaid services. Here are examples of what you'll need: - The full name of the patient/beneficiary - The full name and credentials of the community behavioral health clinic professionals who handled the patient - Documented completed encounters on each day for the patient/beneficiary - Documentation of at least one threshold service performed per encounter (e.g., diagnostic evaluation, psychotherapy, crisis intervention, etc.) - Documentation of the specific services rendered for the encounter - Relevant information and indications concerning the patient/beneficiary's medical history and record that support the (medical) necessity for medical encounters or behavioral health encounters and services rendered to them

## **Billing requirements for T1040** Besides the documentation requirements above, it would be best to take note of or have the following: - 1 unit = 1 per diem, per patient/beneficiary - Use of the HA modifier if the patient/beneficiary is below age 21; HB if they are aged 21+ - Only 1 unit is payable for the same day by the same clinic/provider. Multiple units are denied - Any relevant CPT and ICD codes related to the patient's - Billing of both a medical encounter and a behavioral health encounter on the same date is not allowed - Remember that this is only for Medicaid-certified services

## **Other similar codes** - **T1041** - Medicaid-certified community behavioral health clinic services, per month - **T1015** - Clinic visit/encounter, all-inclusive