On June 1, 2022, the Health and Human Services Commission (HHSC) comprehensively revised the Long-Term Services and Supports (LTSS) Billing Matrix and crosswalk. The note at the top of the matrix now states: “MDCP modifier (U6) added to all state plan services to designate MDCP members on encounter claims, with the exception of STAR Health.” HHSC is notifying STAR Kids MCOs and Providers of changes to the STAR Kids Handbook, Appendix III, Long-term Services and Supports (LTSS) Billing Matrix and Crosswalk.
On March 21, 2023, HHSC hosted a STAR Kids policy call notifying MCOs that they must also add the U6 modifier on all prior authorizations of state plan LTSS for MDCP members. In addition, MCOs are required to educate Providers on this change.
Currently, the billing matrix reflects revenue code 661 (hourly/quarterly) to be billed with HCPCS code S5151 (Out-of-Home Respite (Facility)). This is incorrect, as the unit should be billed as a per diem rate. HHSC will correct this to show revenue code 663 (per diem).
Changes to the STAR Kids Handbook Appendix III, LTSS Billing Matrix, and Crosswalk to reflect the updates mentioned above are forthcoming.
Recommendations:
Providers must add the appropriate U6 modifier included on the authorization to encounter claims for MDCP members.
Resources:
Appendix III, LTSS Billing Matrix and Crosswalk
Community First Resources:
Sign up for our Community First EVV/LTSS Training
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.