News

Community Mental Health Center Duplicate Billing Determination

Date: 11/18/2016

Effective immediately the following changes to duplicate billing determination for CMHCs will be made:

Community Mental Health Centers (CMHCs provider type/provider specialty 11/111) may bill repeat services on separate claims but must append the appropriate modifier (76 or 77) to indicate the service is not duplicate.  The Community Mental Health Center (CMHC) must clearly document in the medical record that a repeat service was performed and the medical necessity/justification for the repeat service.

Thank you,

Network Development Team