Billing Guidance for Comprehensive Assessments

MaineCare case management and behavioral health services providers, including, but not limited to, providers of services covered under MaineCare Benefits Manual (MBM) Sections 13, 17, 28, 65, 89, 92, and 93, are required to conduct Comprehensive Assessments when a member begins a service and at least annually to inform the development of an individual service plan, individual treatment plan, or plan of care.

Providers must only bill for Comprehensive Assessments with the code for the service that the provider is conducting the Comprehensive Assessment for.

  • For services billed with a 15-minute unit, except for services covered under MBM Section 28, the provider must bill for the time spent conducting the Comprehensive Assessment with the same code the service is normally billed with. For example, a MBM Section 17 provider delivering Community Integration Services would bill for the Comprehensive Assessment with H2015.
  • If the service is billed with a per diem, weekly, or monthly rate, then the provider would not bill any additional codes for the time spent conducting the Comprehensive Assessment because that time is already accounted for in the per diem, weekly, or monthly rate. For example, a MBM Section 65 provider delivering Children’s Assertive Community Treatment (ACT) only bills H0040 HA for a week’s worth of Children’s ACT services, which would include any time spent on a Comprehensive Assessment. The Children’s ACT provider must not bill a separate code for the Comprehensive Assessment.
  • For services covered under MBM Section 28, providers do not bill for the time spent conducting the comprehensive assessment because supervisors must complete the Comprehensive Assessment and “providers may not bill for the time supervisors spend delivering services” because “Reimbursement rates for services provided by direct care staff under this Section account for the full cost of the supervisor.” See MBM Section 28.10, Billing Instructions.

In addition, providers should not bill H2000 for the time spent conducting a Comprehensive Assessment. The code H2000 was previously used to bill for the “Outpatient Services Comprehensive Assessment” under the former MBM Section 65.07-5(A). Effective April 28, 2026, H2000 is used to bill for the “Outpatient Diagnostic Assessment” covered in the current MBM Section 65.07-4(C). The section below describes the distinct purpose of the Outpatient Diagnostic Assessment.

Providers that billed H2000 for Comprehensive Assessments that were conducted as part of a behavioral health service that MaineCare reimburses for with a weekly or monthly rate must reverse or adjust, as appropriate, claims for H2000.

Please contact your Provider Relations Specialist with questions about how to appropriately reverse or adjust claims.

For Behavioral Health Home (BHH) and Opioid Health Home (OHH) providers, please contact Kaley Haynes, BHH and OHH Program Coordinator, with questions about how to adjust payment.

 

Outpatient Diagnostic Assessment Clarification

While the Comprehensive Assessment described above may include a determination of a diagnosis, MBM Section 65 providers can deliver the Outpatient Diagnostic Assessment to determine if a member has a behavioral health diagnosis separate from a Comprehensive Assessment.

The following are examples in which a provider could deliver an Outpatient Diagnostic Assessment:

  • A member does not have a behavioral health diagnosis but needs one to be found eligible for a behavioral health service.
  • A member is receiving a behavioral health service, and the service provider suspects the member has an undiagnosed disorder that the service provider cannot diagnose themselves. For example, a Licensed Clinical Social Worker (LCSW) delivering outpatient therapy to a member for major depressive disorder suspects that the member also has Autism Spectrum Disorder (ASD). However, the LCSW does not diagnose ASD, so they refer the member to an outside clinician who can diagnose ASD to deliver the Outpatient Diagnostic Assessment. 

Only providers enrolled under MBM Section 65 can deliver and bill for the Outpatient Diagnostic Assessment. However, providers enrolled under MBM Section 90, Physician Services, can also deliver diagnostic evaluations and bill for them through the appropriate Current Procedural Terminology (CPT) code, such as CPT code 90791.

For questions, please contact your Provider Relations Specialist.