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KMAP BULLETIN: CCBHC Specialty Designation for Prospective Payment System - Code Clarification

Date: 05/23/23


Effective with dates of service on and after May 1, 2022, the following guidelines apply to procedure code 96372 for Community Mental Health Centers (CMHCs) and Certified Community Behavioral Health Clinics (CCBHCs): 

For CMHCs who are Designated as a CCBHC
Procedure code 96372 should only be billed using a CCBHC National Provider Identifier (NPI) when used for the administration of Medication Assisted Treatment (MAT) drugs. This procedure code is not billable by a CCBHC for the administration of any other drug:
        • For service dates between May 1, 2022, and August 31, 2022, procedure code 96372 should be billed without modifier U8.
        • For service dates on and after September 1, 2022, procedure code 96372 is only billable with modifier U8.

For the administration of non-MAT drugs, procedure code 96372 should be billed under the CMHC NPI without modifier U8 regardless of the date of service.

For CMHCs who do not have a CCBHC Designation
Procedure code 96372 is billable for the administration of covered drugs and should be billed without modifier U8 regardless of the date of service

Note: The effective date of the policy is May 1, 2022. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.