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

Learn about the HCPCS code T1040 for "Medicaid certified community behavioral health clinic services, per diem" through this guide.

Use Code

## **What is the HCPCS code T1040 for?** The HCPCS code T1040 is meant to designate the rendering of Medicaid-certified community behavioral health clinic services per day (per diem). It reflects a daily comprehensive per diem rate intended to cover a range of behavioral health services provided in outpatient clinic settings/federally qualified health centers/rural health clinics. Such services include: - Services rendered by licensed clinical social workers - Services rendered by licensed clinical psychologists - Services rendered by licensed clinical professional counselors - Services rendered by licensed marriage and family therapists

## **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

Frequently asked questions

At least one threshold behavioral health service (e.g., psychotherapy, diagnostic eval, crisis intervention) must be delivered on that day to justify billing the per diem rate.

No. T1040 replaced T1015 for behavioral health clinic encounters. Billing both for the same patient/provider/day will result in denial.

No. This code is per patient, per diem. They must be billed separately.