MedicaidCoverageMedium impact
PT 09-26: Updated Clarification on MCO Payment Responsibility for Health Behavior Assessments Administered in an Acute Care Setting
Maryland Medicaid·MD · Psychiatry, Emergency Medicine·Claims & Billing
Effective date
Jan 1, 2025
We identified it
Jun 18, 2026
Summary
Maryland clarifies that Managed Care Organizations (MCOs) are responsible for reimbursing health behavior assessments (CPT 96156) performed in acute hospital settings when billed with primary somatic diagnoses. This supersedes previous guidance PT 80-25 and establishes a fee-for-service rate of $102.83 for these assessments.
Action Required
Immediately: Maryland providers should verify billing system settings for CPT 96156 health behavior assessments in inpatient (POS 21) and outpatient hospital (POS 22) settings. Ensure claims are directed to MCOs rather than fee-for-service when performed by psychologists, nurse psychotherapists, or licensed certified social workers. Update encounter forms to reflect $102.83 reimbursement rate for fee-for-service cases.