Mercy Care DCS CHP EPSDT Update

www.MercyCareAZ.org

January 23, 2022

Applicable to: Mercy Care DCS CHP

Effective March 1, 2023, Mercy Care will be implementing a rate enhancement for the following codes for DCS CHP only; specifically, these codes will be reimbursed at 200% of our Mercy Care Fee Schedule.

NOTE: Modifier TJ is for tracking Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for those in Foster Care who require a specific visit within a specific time to meet policy requirements. This is not to be used for any other EPSDT visit. Please visit the Mercy Care webpage for more information on the use of this modifier. Claims submitted without this modifier will not receive the enhanced rate. Any claims submitted with modifier TJ on lines of business (LOBs) other than Department of Child Safety Comprehensive Health Plan (DCS CHP) will deny.

CODE	DESCRIPTION	MODIFIERS
99201	New Patient Office or Other Outpatient Visit, typically 10 Minutes	TJ - Program Group, Child/Adolescent
99202	New Patient Outpatient Visit, Total Time 15-29 Minutes	TJ - Program Group, Child/Adolescent
99203	New Patient Office or Other Outpatient Visit, 30-44 Minutes	TJ - Program Group, Child/Adolescent
99204	New Patient Office or Other Outpatient Visit, 45-59 Minutes	TJ - Program Group, Child/Adolescent
99205	New Patient Office or Other Outpatient Visit, 60-74 Minutes	TJ - Program Group, Child/Adolescent
99211	Office Or Other Outpatient Visit for The Evaluation And Management Of Established Patient That May Not Require Presence Of Healthcare Professional	TJ - Program Group, Child/Adolescent
99212	Established Patient Office Or Other Outpatient Visit, 10-19 Minutes	TJ - Program Group, Child/Adolescent
99213	Established Patient Office Or Other Outpatient Visit, 20-29 Minutes	TJ - Program Group, Child/Adolescent
99214	Established Patient Office Or Other Outpatient Visit, 30-39 Minutes	TJ - Program Group, Child/Adolescent
99215	Established Patient Office Or Other Outpatient Visit, 40-54 Minutes	TJ - Program Group, Child/Adolescent
99381	Initial New Patient Preventive Medicine Evaluation (Younger Than 1 Year)	TJ - Program Group, Child/Adolescent
99382	Initial New Patient Preventive Medicine Evaluation (1-4 Years)	TJ - Program Group, Child/Adolescent
99383	Initial New Patient Preventive Medicine Evaluation (5-11 Years)	TJ - Program Group, Child/Adolescent
99384	Initial New Patient Preventive Medicine Evaluation (12-17 Years)	TJ - Program Group, Child/Adolescent
99385	Initial New Patient Preventive Medicine Evaluation (18-39 Years)	TJ - Program Group, Child/Adolescent
99391	Established Patient Periodic Preventive Medicine Examination (Younger Than 1 Year)	TJ - Program Group, Child/Adolescent
99392	Established Patient Periodic Preventive Medicine Examination (1-4 Years)	TJ - Program Group, Child/Adolescent
99393	Established Patient Periodic Preventive Medicine Examination (5-11 Years)	TJ - Program Group, Child/Adolescent
99394	Established Patient Periodic Preventive Medicine Examination (12- 17 Years)	TJ - Program Group, Child/Adolescent
99395	Established Patient Periodic Preventive Medicine Examination (18-39 Years)	TJ - Program Group, Child/Adolescent

As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.

Thanks for all you do!

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