Summary & Overview
HCPCS T1041: Medicaid Community Behavioral Health Clinic Services, Monthly
HCPCS Level II code T1041 designates Medicaid-certified community behavioral health clinic services billed on a monthly basis. This code captures ongoing, clinic-based behavioral health care delivered through Medicaid-certified community behavioral health clinics and is important for tracking access to longitudinal behavioral health services for Medicaid beneficiaries. Nationally, the code matters because it standardizes monthly billing for integrated outpatient behavioral health programs that serve high-need populations, contributing to service continuity and program accountability.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how T1041 is used in clinical billing, typical sites of service, and the role the code plays in program administration and payer contracting. The publication summarizes benchmark concepts, relevant policy and coverage considerations, and clinical context for community-based behavioral health delivery. If specific payer reimbursement or state program details are needed, those are addressed in payer-specific sections; national context and common implementation themes are provided here.
What readers will learn: the clinical scope represented by T1041, typical settings where it is applied, which major payers include similar program coverage, and where to look for further policy or billing guidance. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code T1041 represents Medicaid certified community behavioral health clinic services, billed per month. The service type is community behavioral health clinic services, reflecting comprehensive, ongoing behavioral health care coordination and support provided by Medicaid-certified clinics. The typical site of service is community behavioral health clinics (Medicaid-certified outpatient clinic settings) where beneficiaries receive integrated mental health and substance use disorder services on an ongoing monthly basis.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A Medicaid-enrolled adult with a diagnosis of major depressive disorder presents to a certified community behavioral health clinic (CCBHC) for ongoing monthly outpatient behavioral health services. The patient receives a coordinated package of care delivered by a multidisciplinary team including a licensed clinical social worker, psychiatric nurse practitioner, and a licensed psychologist. During the monthly enrollment period the clinic documents care management activities (medication monitoring and reconciliation by the psychiatric nurse practitioner), psychotherapy (individual or group sessions by licensed clinicians), crisis assessment as needed, care coordination with the patient’s primary care provider, and rehabilitation supports (skills training and community resource linkage). Billing uses T1041 to capture the per-month Medicaid-certified community behavioral health clinic services for the covered month. Typical workflow: intake and problem list verification, team care planning, at least monthly clinical contact(s) documented in the medical record, medication management visits or psychotherapeutic encounters as clinically indicated, documentation of care coordination and measurable outcomes, and submission of T1041 as the monthly wrap-around clinic service code with applicable modifier(s) reflecting billing circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |