25-607 Use Correct CPT Codes and Modifiers When Billing for Mobile Crisis Services

Date: 06/25/25

Include required information on claims using DMHC guidelines so claims process correctly

The Department of Managed Health Care (DMHC) issued All Plan Letter (APL) 25-006: Health plan coverage of mobile crisis services (PDF), dated March 21, 2025, to clarify what information needs to be on claims submitted by a 988 center or mobile crisis team for behavioral health (BH) crisis services. View the information below that outlines the specific codes, modifiers and place of service that must be included on a claim for BH mobile crisis services so the claim will process at a member’s in-network benefit.

• Mental health and substance use disorder treatment provided by a 988 center or mobile crisis team are covered without prior authorization until the patient is stabilized.
• Covered services are processed at the member’s in-network benefit rate if they are provided out-of-network. The enrollee is not required to pay more than the cost sharing they would pay if the services were received from an in-network provider.

Submit a clean claim

Before you begin, you can go to the Provider Manual under Claims and Provider Reimbursement for a list of topics that will help you with questions about how to fill out a claim for – professional (CMS-1500 form) or institutional (UB-04 form) services, including a section on Billing and Submission.

Use CPT codes specific to BH crisis services

The following are examples of the CPT billing codes to use for BH crisis services provided in the DMHC APL. This is not intended by the DMHC to be a complete list of qualifying codes. Note: Claims not billed with one of the CPT or HCPCS codes below will apply standard benefits and cost share based on the member’s plan:

Reimbursable billing codes for crisis services

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CPT/HCPCS	Description
H0007	Alcohol and/or drug services; crisis intervention (outpatient).
H0030	Behavioral health hotline services.
H0018	Short-term residential (non-hospital residential program), without room and board, per diem.
H2011	Crisis intervention service, per 15 minutes.
H2017	Psychosocial rehabilitation services (skills building with consumers/collateral around safety planning), per 15 minutes
T1017	Targeted case management services (and linkage follow up to assist with the stabilization of the member), each 15 minutes.
S9484	Crisis intervention mental health services, per hour.
S9485	Crisis intervention services, per diem.
90791	Psychiatric diagnostic evaluation service.
90792	Psychiatric diagnostic evaluation with medical services, performed by a licensed mental health physician or other provider.
90839	Crisis psychotherapy; first 60 minutes of a crisis session.
90840	Psychotherapy for crisis; each additional 30 minutes. (Add on code used with 90839. List separately in addition to code for primary service.)
G0017	Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes.
G0018	Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes. (List separately in addition to code for primary service.)
G0544	Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, per calendar month. (Covers four monthly calls.)
G0560	Safety planning interventions, each 20 minutes.
REV 900/S9484	Crisis intervention mental health services, per hour.
REV 900/S9485	Crisis intervention mental health services, per diem.

 

Eligible provider types and modifiers

For BH mobile crisis services to be reimbursed at the member’s in-network benefits, the claim must be submitted under a licensed provider with the appropriate modifier as shown in the table below. Pre-licensed associates must bill under a licensed provider. Note: Claims not billed with one of the applicable modifiers below will apply standard benefits and cost share based on the member’s plan.

Description/licensure	HIPAA Modifier	HIPAA modifier description
Psychiatrist	AF	Specialty physician
Physician	AG	Primary physician
Psychologist	AH HP	Clinical psychologist or Doctoral level
Social worker	AJ	Clinical social worker
Master’s level counselor	HO	Master’s degree level
Clinical nurse specialist/physician assistant	SA TD	Nurse practitioner RN
National certified addiction counselor or state substance abuse counseling certification	HF	Substance abuse program
Bachelor’s level counselors	HN	Bachelor’s degree level
Less than bachelor’s level counselors	HM	Less than bachelor’s degree level

 

Place of service (POS) on professional claims

For BH mobile crisis services to be reimbursed at the member’s in-network benefits, the professional claim (CMS-1500 form) must be submitted with POS 15-Mobile Unit. Note: Claims not billed with POS 15 will apply standard benefits and cost share based on the member’s plan.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.

Behavioral health providers can call 844-966-0298.

Provider Services

Line of business	Phone number	Email
Ambetter from Health Net IFP Ambetter PPO	844-463-8188	email
Ambetter HMO	888-926-2164	email
Health Net Employer Group HMO, POS, & PPO	800-641-7761	email
Behavioral Health providers	844-966-0298	N/A

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.

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