The four types of DMH medical services that are not covered by Medicare or other third-party insurance and are allowable towards a participant’s spend down can be identified through the provider type, designated by the first two digits of the Medicaid provider number.
Each is billed using a provider type that is specific to the services:
- 87 – Community Psychiatric Rehabilitation (CPR)
- 86 – Comprehensive Substance Abuse Treatment and Rehabilitation (CSTAR)
- 85 – Developmentally Disabled 1915(c) waiver services
- 15 – Targeted Case Management (TCM) for Individuals with Developmental Disabilities (DD), for adults with Serious Mental Illness (SMI), and for children with a Severe Emotional Disturbance (SED)