Summary & Overview
HCPCS Level II T1040: Medicaid Community Behavioral Health Clinic Per Diem
HCPCS Level II code T1040 denotes Medicaid-certified community behavioral health clinic services billed on a per diem basis. This code is used to capture daily clinic-level behavioral health services delivered by certified community behavioral health clinics, an important mechanism for reimbursing comprehensive outpatient behavioral health care that often includes care coordination and multiple therapeutic modalities within a single day rate. Nationally, T1040 matters because it standardizes billing for clinic per diems that support access to behavioral health services for Medicaid enrollees and can affect provider participation and service availability.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how T1040 is defined and used, typical sites of service, common modifiers associated with billing practices, and the scope of analyses typically performed for per diem behavioral health codes. The publication summarizes benchmarks and payment considerations, outlines policy and coverage contexts affecting use of HCPCS Level II code T1040, and provides clinical context for services bundled under a per diem approach. Data not available in the input for specific taxonomies, ICD-10 mappings, and related codes are noted.
Billing Code Overview
HCPCS Level II code T1040 represents Medicaid certified community behavioral health clinic services, billed on a per diem basis. The service type is community behavioral health clinic per diem services, reflecting daily rates for clinic-based behavioral health care provided by Medicaid-certified community behavioral health clinics. The typical site of service is community behavioral health clinics / outpatient clinic settings.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 28-year-old adult enrolled in Medicaid presenting to a Medicaid-certified Community Behavioral Health Clinic (CBHC) for intensive, coordinated behavioral health services. The patient has a diagnosis of major depressive disorder with comorbid substance use disorder and requires a full day of clinic-based care that includes medication management, individual therapy, group therapy, case management, and care coordination with social services. The clinic documents admission, daily service components, and progress notes; the per diem billing code T1040 is used to bill a single full-day unit of CBHC services when the patient receives the comprehensive package of services defined by the state Medicaid program.
The clinical workflow begins with an intake assessment and treatment planning, followed by scheduling of daily services. On the day of service, the patient attends medication management with a psychiatric prescriber, one or more therapy sessions (individual or group) with licensed clinicians, and meets with a case manager for linkage to housing and employment resources. The clinic documents time, service components, and staff disciplines involved. If services are curtailed by the patient (e.g., early discharge), modifiers may adjust billing to reflect partial or discontinued services. Coordination with external providers (primary care, specialty mental health) is documented in the medical record as part of the per diem deliverables.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |