Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBeacon Medicaid BHCSC Coverage Update | OpenPayer
    Ask Trek AI about this page
    CurrentBeacon-Health-OptionsPolicy N/A

    Medicaid Coverage of Behavioral Health Crisis Stabilization Center Services

    Customize your policy alerts

    Sign up for all Beacon-Health-Options policy alerts

    Know when Beacon-Health-Options releases new policies or updates existing guidance.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Establishes Maryland Medicaid coverage, provider eligibility, enrollment requirements, and reimbursement for behavioral health crisis stabilization center services.

    Policy Summary
    PayerBeacon-Health-Options
    PolicyMedicaid Coverage of Behavioral Health Crisis Stabilization Center Services
    Policy CodePolicy N/A
    Change TypeNew policy
    Effective DateJune 1, 2024
    Next Review DateN/A
    Key ActionObtain and maintain a Behavioral Health Administration license as a BHCSC program and active enrollment in Maryland Medicaid.
    SourceLink
    POLICY UPDATE CHANGES

    Maryland Medicaid establishes reimbursement for behavioral health crisis stabilization center services.

    24/7Provider availability
    <24 hoursMaximum service duration
    $721.21FY 2024 S9485 rate
    $742.85FY 2025 S9485 rate

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    1
    Additional E/M codes

    Coverage Criteria

    BHCSC Provider Eligibility

    BHCSC providers are eligible for Medicaid reimbursement only when ALL of the following requirements are met:

    ALL of the following

    • Provider is licensed by the Behavioral Health Administration (BHA) as a BHCSC program.
    • Provider is actively enrolled in Maryland Medicaid.
    • Provider is open and available 24 hours per day, seven days per week.
    • Provider complies with the staffing and service requirements outlined in COMAR 10.63.03.21.
    • All staff receive crisis training approved by BHA.
    • All staff receive appropriate supervision in accordance with COMAR 10.63.03.21.

    Service Coverage and Billing Criteria

    BHCSC services and reimbursement are covered when ALL applicable service and billing criteria are met:

    ALL of the following

    • Service provides short-term stabilization, assessment, and intervention for individuals experiencing urgent symptoms or behaviors that interrupt behavioral health functioning.
    • Service is provided in a facility open 24 hours per day, seven days per week and staffed to manage the full array of behavioral health emergencies, including alcohol and substance misuse, symptoms of mental illness, and emotional distress.
    • Service is outpatient and limited to less than 24 hours.< 24 hours
    • Service is intended to provide the least restrictive environment for individuals at risk for emergency department visits, hospitalization, or incarceration.

    Coding and Reimbursement

    BHCSC serviceHCPCSCovered
    S9485Behavioral health crisis stabilization center services
    Additional psychiatric E/M serviceCPTCovered
    Office-based Evaluation and Management codeOne additional office-based Evaluation and Management code per admission episode for evaluations rendered by a psychiatrist or psychiatric nurse practitioner
    Service Duration
    Maximum service durationLess than 24 hours
    Additional E/M Billing
    Additional E/M billing limitOne office-based Evaluation and Management code per admission episode

    Provider Enrollment and Billing Actions

    Documentation Required

    BHCSC Licensure and Medicaid Enrollment Required

    Obtain a Behavioral Health Administration (BHA) license as a Behavioral Health Crisis Stabilization Center (BHCSC) program and maintain active enrollment with Maryland Medicaid to qualify for Medicaid reimbursement.

    Note

    Continuous Availability Required

    Operate and remain open and available continuously, 24 hours per day, seven days per week.

    Documentation Required

    Staffing, Training, and Supervision

    Meet the staffing and service requirements in COMAR 10.63.03.21. Ensure every staff member receives BHA-approved crisis training and appropriate supervision in accordance with COMAR 10.63.03.21.

    Key Definitions

    Behavioral Health Crisis Stabilization Center Service
    Service typeOutpatient behavioral health crisis stabilization service
    Core servicesShort-term stabilization, assessment, and intervention
    Individuals servedIndividuals experiencing urgent symptoms or behaviors that interrupt behavioral health functioning
    BHCSC Facility
    Operating scheduleOpen 24 hours a day, seven days a week
    Staffing capabilityStaffed to manage the full array of behavioral health emergencies
    Emergencies addressed
    Policy Summary
    PayerBeacon-Health-Options
    PolicyMedicaid Coverage of Behavioral Health Crisis Stabilization Center Services
    Policy CodePolicy N/A
    Change TypeNew policy
    Effective DateJune 1, 2024
    Next Review DateN/A
    Key ActionObtain and maintain a Behavioral Health Administration license as a BHCSC program and active enrollment in Maryland Medicaid.
    SourceLink
    On This Page
    Coverage CriteriaCoding and ReimbursementProvider Enrollment and Billing ActionsKey Definitions
    HCPCS code S9485 is billed for behavioral health crisis stabilization center services on a per diem basis for less than 24 hours and per admission episode.
  1. S9485 reimbursement rate is $721.21 for FY 2024, effective June 1, 2024.

    FY 2024 rate effective date: 6/1/2024.

  2. S9485 reimbursement rate is $742.85 for FY 2025, effective July 1, 2024.

    FY 2025 rate effective date: 7/1/2024.

  3. No more than one office-based Evaluation and Management code is billed per admission episode, and the evaluation is rendered by a psychiatrist or psychiatric nurse practitioner.1 office-based E/M code per admission episode
    4. Documentation Required

    Complete ePREP Enrollment After Licensure

    After obtaining the BHA-issued BHCSC license, enroll with Maryland Medicaid by completing the application through Maryland Medicaid’s Electronic Provider Revalidation and Enrollment Portal (ePREP) and submitting the required enrollment materials.

    • Complete the Maryland Medicaid enrollment application in ePREP after licensure.
    • Submit the BHCSC provider enrollment application and required supporting documentation.
    • ePREP resources and guidance: https://health.maryland.gov/mmcp/provider/Pages/enrollment.aspx
    • BHCSC addendum download: https://health.maryland.gov/mmcp/provider/Pages/eprepforms.aspx
    Documentation Required

    Required Enrollment Documentation

    Include all required documentation with the Maryland Medicaid BHCSC enrollment submission.

    • Signed IRS W-9 form.
    • BHA license for BHCSC.
    • Completed and signed BHCSC provider addendum.
    • Pre-employment background check results for each staff member.
    • Agency background check policy.
    Prior Authorization

    Enrollment Site Visit Required

    A site visit is required to finalize Maryland Medicaid enrollment after the ePREP application and supporting documentation are submitted.

    Billing Rule

    One Additional Psychiatric E/M Code per Episode

    Providers may additionally bill one office-based Evaluation and Management (E/M) code per admission episode when the evaluation is rendered by a psychiatrist or psychiatric nurse practitioner.

    • Limit: one office-based E/M code per admission episode.
    • Eligible rendering clinicians: psychiatrist or psychiatric nurse practitioner.
    Alcohol and substance misuse, symptoms of mental illness, and emotional distress
    Outpatient Service
    Care settingOutpatient service
    DurationLimited to less than 24 hours
    PurposeProvides the least restrictive environment for individuals at risk for emergency department visits, hospitalization, and incarceration