IHCP to Cover Bridge Appointments

Did you hear that the Indiana Health Coverage Programs (IHCP) will begin to pay for “bridge appointments” for members covered under the Care Select and Traditional Medicaid Fee-for-Service programs on or after December 1, 2011?  What is a Bridge Appointment you may ask?  It is described as a “follow up appointment after an inpatient hospitalization for behavioral health issues when no outpatient appointment is available within seven days of discharge.  The goal of the bridge appointment is to provide proper discharge planning and to establish a connection between the member and the outpatient treatment provider.”  In order to be reimbursed for this service, practitioners must be qualified mental health providers (as defined in the IHCP bulletin via the provided link below) and meet the following conditions:

  • Appointments must be face to face in an outpatient setting (can be outpatient at the hospital facility) on the day of discharge from inpatient
  • Must be a minimum of 15 minutes
  • The member must have one or more identified barriers to continuing care (provided in IHCP bulletin – link below)
  • The member must have a specific diagnostic code (applicable codes listed in IHCP bulletin – link below) in order to qualify for this service.  However, please note that it is possible for other individuals who have differing codes to qualify but the documentation must justify that this was necessary
  • The service must include discussion of prescribed medication treatment regimen
  • Verification that the member has ongoing outpatient care
  • If family present, that they are aware of the discharge instructions for the member
  • Identify and address any barriers for continuing care (e.g. transportation; child care, etc.)
  • Answer any additional questions from the member or member’s significant others
  • Bill for the bridge appointments on a CMS-1500 form with CPT code 99401 with a HK modifier.  The established reimbursement rate is $20.00 per member, per hospitalization (one unit, per member, per hospitalization).

For more detailed information regarding this significant change please access the following link: