Benefit Limit Information and Timelines

The State of Colorado Department of Healthcare Policy and Finance modified the Medicaid mental health benefit package effective September 1, 2003 as follows:

Outpatient Services: A maximum of 35 sessions for individual and brief therapy (CPT Codes: 90804, 90805, 90806 and 90807) per fiscal year. These 35 sessions include sessions provided at mental health centers and through other Medicaid mental health providers. Treatment beyond these 35 sessions will not be reimbursed. (Example: a member has received 20 individual sessions at the mental health center, only 15 more individual or brief sessions will be reimbursed either at the mental health center or with an external contracted provider.) Treatment provided through group sessions, family therapy and medication management are not included.

 

Inpatient Services: The new benefit allows up to 45 inpatient hospital days per fiscal year. Facilities will not be reimbursed beyond the 45-inpatient day limit for hospital stays (Example: a member has received 30 in-patient days at a mental health institute or another facility, only 15 more days will be reimbursed.)

 

The fiscal year is defined as July 1^st through June 30^th. If you provided services to a client in one of the above categories since July 1, 2004 those sessions count toward the yearly total. The new contract does not affect the overall total of the session limits for a member.