NYS OMH Mobile Crisis Program Guidance — Mobile and Telephonic Behavioral Health Crisis Services Coverage Criteria
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Guidance for New York State–approved Mobile Crisis providers eligible for reimbursement under the Medicaid Managed Care 1115 Crisis Intervention benefit; covers service standards, staffing, training, service types, and documentation expectations for providers delivering telephonic and mobile behavioral health crisis services.
Policy Summary
Payerelderplan
PolicyMobile and Telephonic Behavioral Health Crisis Services — coverage criteria and billing guidance
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionProviders must be approved by the state and contract with Medicaid Managed Care plans to be reimbursed under the 1115 Crisis Intervention benefit.
No material clinical or coverage changes in this revision.
24/7/365required availability for mobile and telephonic crisis response
3 hoursin-person intervention target after determination of need
1115Medicaid Managed Care Crisis Intervention benefit identifier
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Naloxone required
training requirement for staff
24 hoursfollow-up/contact initiation after initial BH crisis
14 daysfollow-up services reimbursable period
Coverage Criteria for Mobile Crisis Services
inv-01: Covered Mobile Crisis Services
Covered when service elements and urgency criteria are met
Eligibility and Purpose: Service is for children and adults experiencing or at imminent risk of a BH crisis; intended to assess, de-escalate, stabilize, engage supports, and link to follow-up services.
Service Modalities: Includes telephonic triage/response, mobile crisis response, telephonic follow-up, and mobile follow-up delivered 24/7/365.
References availability requirement.
Mobile Response Timing: Mobile crisis response should provide an in-person intervention within 3 hours of determination of need.<= 3 hours
Staffing: Mobile crisis teams must include a licensed staff and another licensed or nonlicensed staff (in certain circumstances one licensed staff may suffice); providers must maintain staffing plans demonstrating qualified coverage 24/7/365.
Lists eligible licensed and non-licensed roles.
inv-02: Covered Mobile Crisis Services
Covered when services meet definitions of a qualifying BH crisis episode and are documented appropriately:
Mobile Crisis Response Components: Immediate review of safety concerns; assessment of behavioral health symptoms and crisis-related needs; therapeutic communication to alleviate psychiatric or substance use symptoms; involvement of identified providers/supports; linkage to urgent psychopharmacology when needed; determination of community safety; development of safety plan if able to remain in community or direct linkage to higher level of care if not; disposition including referral to appropriate level of care or inpatient evaluation when necessary.
Derived from intervention and disposition sections.
Follow-up Services: Mobile and telephonic follow-up services (face-to-face or telephonic) provided to recipients who meet criteria for a qualifying BH crisis, including short-term re-assessment, therapeutic communication, facilitation of engagement in outpatient BH services, care coordination, and confirmation of connections to care. Follow-up contact initiated within 24 hours or next business day; reimbursable within 14 days for Medicaid managed care enrollees.24 hours; 14 days
Follow-up examples and timing requirements provided.
inv-03: Telephonic and mobile follow-up reimbursement
Coverage for follow-up services
Follow-up reimbursement conditions: Follow-up services are eligible for reimbursement if provided within 14 days of the qualifying crisis episode and billed with the appropriate rate code per MMCO/NYS HARP claiming processes.14 days
Claims must use the appropriate rate code and follow NYS HARP/Mainstream Behavioral Health Billing and Coding Manual.
inv-04: Billing and unit limits
Billing service mappings and limits
Service-to-code mappings: Specific service types (telephonic crisis triage/response, mobile crisis response, telephonic follow-up, mobile follow-up) must be billed using specified rate codes, CPT/Supplemental codes, modifiers, unit measures, and unit limits as listed in the guidance. Different provider types (licensed vs unlicensed/certified peer) map to different rate codes and modifiers.unit measures vary (15 minutes; per-diem where specified)
Unit limits and per-diem rules are provided per service and provider type in the billing tables.
If, during telephonic triage, it is determined that the situation requires an emergency department level of care, mobile crisis response is not the appropriate next step. Telephonic crisis triage must document the preliminary assessment elements (caller and location, presenting problem, risk of harm, medication and substance use, medical stability) and the clinical determination that an ED-level transfer is needed rather than dispatching an in-person mobile response.
Services that do not occur within the context of a potential or actual psychiatric crisis are outside the scope of the Mobile Crisis benefit. Prior authorization and retrospective review are not required for Mobile or Telephonic Crisis Response Services, but coverage applies only when services meet the crisis context described in the guidance.
To be eligible for reimbursement as a Mobile Crisis Provider under the 1115 Crisis Intervention Benefit, a provider must be identified in the County/Regional Crisis Response Plan by the County Director of Community Services and must apply to the state for approval. Providers not identified in the county plan or not approved by the state are not eligible for reimbursement.
Codes, Units, and Billing
Mobile Crisis rate codes, CPT/HCPCS and modifiersmixed
4609
Rate code for Licensed Professional Telephonic Crisis Triage and Response
4610
Rate code for Unlicensed/Certified Peer Telephonic Crisis Triage and Response
4611
Rate code for Licensed Professional Telephonic Crisis Triage (S9485 mapping)
4612
Rate code for Unlicensed/Certified Peer Telephonic Crisis Triage (S9485 mapping)
4615
Rate code for One-person Licensed Mobile Crisis Response
4616
Rate code for Two-person Licensed + Unlicensed/Certified Peer Mobile Crisis Response
4617
Rate code for Two-person Both Licensed Mobile Crisis Response
4618
Rate code for Two-person Licensed + Unlicensed/Certified Peer Per Diem Response (S9485)
4619
Rate code for Two-person Both Licensed Per Diem Response (S9485)
4620
Rate code for Two-person Licensed + Unlicensed/Certified Peer long face-to-face response (S9485)
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1/3
Unit measures and limits — inv-09
Unit measure15 minutes per unit
Common per-day limit (many one-person or mobile services)Up to 90 minutes (6 units)
Telephonic follow-up per-day limitUp to 60 minutes (4 units)
Per-diem/longer response unitPer Diem (90-180 minutes = 1 unit) for specified two-person S9485 responses
Provider Responsibilities and Operational Rules
Prior Authorization
State approval & Medicaid contracting required
Providers must be approved by NYS and contract with Medicaid Managed Care plans to be reimbursed under the 1115 Crisis Intervention benefit; eligible providers are identified by local county mental hygiene directors and approved by the state.
County Directors of Community Services must identify the provider in a County/Regional Crisis Response Plan.
The identified provider must apply to the state for approval.
Approved providers must contract with Medicaid Managed Care plans for reimbursement.
Prior Authorization
No prior authorization or retrospective review required
Prior authorization and retrospective review are not required for Mobile or Telephonic Crisis Response Services; however, services must occur in the context of a potential or actual psychiatric crisis.
Do not submit prior authorization requests for mobile or telephonic crisis response for services meeting crisis context.
Background and Context
Mobile Crisis services provide rapid assessment, de-escalation, stabilization and linkage for individuals experiencing or at imminent risk of a behavioral health crisis. Services include telephonic crisis triage (available 24/7/365), in-person mobile crisis response when indicated, and follow-up activities; telephonic triage performs a preliminary assessment to determine need for further evaluation or in-person response and documents caller/recipient identifiers, location, presenting problem, risk of harm, medication/substance use, and medical stability.
Definitions
Behavioral Health (BH) crisis — definition summary
Definition (summary)An unplanned event requiring a rapid response where an individual cannot manage primarily psychiatric and/or substance use related symptoms without de-escalation or intervention
ScopeIncludes situations with escalation in psychiatric or substance use symptoms or imminent risk of such escalation
Purpose of responseAssess immediate crisis, facilitate resolution/de-escalation, and provide community-based crisis services
Behavioral Health (BH) Crisis — inv-25
DefinitionAn unplanned event that requires a rapid response in which an individual cannot manage their primarily psychiatric and/or substance use related symptoms without de-escalation or intervention.
Includes
Level of Care and Response Criteria
Treatment Modalities Provided During Crisis Response
inv-35: Crisis Intervention and Community Stabilization
Intervention elements: Therapeutic communication, involvement of supports/providers, linkage to urgent psychopharmacology when needed, safety determination and safety plan development if remaining in community.
inv-36: Therapeutic communication and urgent psychopharmacology
Therapeutic communication and medication interventions: Use of therapeutic communication/interactions and linkage to urgent psychopharmacology intervention as needed to address acute psychiatric or substance use symptoms during crisis response.
Included as part of crisis intervention definition and intervention activities.
Visit Limits and Reimbursable Timeframes
Mobile and telephonic follow-up for Medicaid managed care enrollees — inv-37
Reimbursable follow-up windowFollow-up contacts are reimbursable if provided within 14 days of the qualifying BH episode for Medicaid managed care enrollees
Initiation timingFollow-up contact should be initiated within 24 hours of the initial BH crisis or by the next business day
Delivery modesFollow-up may be telephonic or face-to-face and include therapeutic communication, care coordination, and confirmation of linkages to services
Telephonic Crisis Triage/Response, Mobile Crisis Response, Telephonic Follow-Up, Mobile Follow-Up — inv-38
Maximum session length (many services)Up to 90 minutes (6 units) per day for many one-person and mobile responses
Telephonic services limit
Policy Summary
Payerelderplan
PolicyMobile and Telephonic Behavioral Health Crisis Services — coverage criteria and billing guidance
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionProviders must be approved by the state and contract with Medicaid Managed Care plans to be reimbursed under the 1115 Crisis Intervention benefit.
Documentation of crisis and follow-up services in recipient's chart within 24 hours; mobile response documentation must include rationale, presenting problem, mental status exam, history, collaterals, medications and compliance, supports, safety assessment/plan, consents, date/duration, and copy of safety plan; QA plan must document requests, timing, grievances, staff qualifications/training, and incident reports.
24 hours
See documentation and quality assurance sections.
Ensure the service clearly documents that it occurred within a potential or actual psychiatric crisis to meet this requirement.
Billing Rule
Use correct rate codes and MMCO claiming processes
All claims must be submitted with the appropriate rate code for the service provided and follow MMCO claiming processes per the NYS HARP/Mainstream Behavioral Health Billing and Coding Manual.
Use the specified rate code that corresponds to the service type and provider mix (see rate code tables in billing guidance).
Follow MMCO/NYS HARP claiming processes when preparing and submitting claims.
Step Therapy
Telephonic-first triage to determine need for mobile response
Telephonic triage must perform a preliminary assessment to determine whether in-person mobile response is necessary and may provide linkage/referral to less restrictive community services, develop/review a safety plan, and document disposition.
Collect caller/recipient identifiers, location, supports present, presenting problem, risk of harm, medication/substance use and medical stability during telephonic triage.
If ED-level care is not required, further telephonic assessment should evaluate history, treatment, and supports to decide on mobile response versus community referrals.
Prior Authorization
Provider identification in County plans and state approval required
Mobile crisis providers must be identified in County Mobile Crisis Response Plans and approved by the state to be reimbursed under the 1115 Crisis Intervention benefit.
County plans include the process for oversight and must identify the mobile crisis provider.
Identified providers must apply to the state for approval before billing as Mobile Crisis Providers.
Note
Provider approval is mandatory for reimbursement
Providers must be OMH/NYS-approved Mobile Crisis Providers to be reimbursed; maintain written highlight that approval is mandatory and that contracting with Medicaid Managed Care is required for billing under the 1115 benefit.
Approval by the state is a prerequisite to reimbursement under the 1115 Crisis Intervention Benefit.
Approved providers must contract with Medicaid Managed Care plans for reimbursement.
Documentation Required
Document all services and attempts to collect required information
Document all services provided, including telephonic triage, mobile response, and follow-up activities, and efforts to enroll the recipient/family/caregiver in supports; telephonic attempts to collect required information must be documented.
Telephonic documentation must include at minimum the preliminary telephonic triage elements and call disposition (safety plan, referrals).
Document attempts to collect caller/recipient information if refused.
Progress notes for follow-up must be signed by assigned staff and recorded within required timeframes.
Documentation Required
Document crisis services in chart within 24 hours with required elements
Crisis services must be documented in the recipient's chart within 24 hours (or by the next business day) to identify discrete billable crisis response services related to a qualifying episode and/or within a 14-day follow-up period; mobile response documentation must include detailed clinical elements and a copy of the safety plan.
Mobile response documentation must include rationale for response, presenting problem, mental status exam, history, collaterals, medication review/compliance, supports, safety assessment/plan, consents, date/duration, and copy of safety plan.
Follow-up documentation must include content of follow-up contacts, (re)linkage efforts, barriers, and progress notes signed by the providing staff.
Documentation Required
Create individualized collaborative Safety Plan
Develop an individualized Safety Plan collaboratively with the individual, mobile crisis staff, and supports; the plan should state direct interventions during a crisis and include follow-up needs, linkage to treatment, antecedents, strengths, coping skills, and roles/responsibilities.
Include need for follow-up phone calls or face-to-face visits and assistance with linking to treatment.
Document antecedents, supports, strengths, coping skills, and participant roles in the safety plan.
Documentation Required
Maintain provider and staff qualification documentation
Maintain documentation proving provider and staff qualifications: providers must be identified in County/Regional Crisis Response Plans and approved by NYS; qualified non-licensed staff must meet the stated age, education, and experience criteria.
Ensure staff clear NYS Staff Exclusion List, Criminal Background Check, and Statewide Central Register checks.
Keep records showing qualified non-licensed staff meet age (18+), education (HS or BA), and experience (1–3 years) requirements.
Denial Risk
Reimbursement denial risk if not state-approved or contracted
Failure to be an OMH/NYS-approved Mobile Crisis provider and to contract with Medicaid Managed Care plans, or failure to meet staff screening requirements, may prevent reimbursement; services must be documented and staff must clear required NYS background/exclusion checks.
If not state-approved or not contracting with Medicaid Managed Care, claims may be denied.
Staff must clear NYS Staff Exclusion List, Criminal Background Check, and Statewide Central Register to meet eligibility requirements.
Denial Risk
Coverage protections: no denials or prior auth for qualifying crisis services
Coverage may not be denied and prior authorization/retrospective review is not required for Mobile or Telephonic Crisis Response Services when services occur within the context of a potential or actual psychiatric crisis.
Ensure documentation demonstrates the service occurred within a psychiatric crisis to support coverage without prior authorization.
Denial Risk
Follow-up reimbursement limited to 14-day window
Follow-up services are eligible for reimbursement only if provided within 14 days of the qualifying crisis episode; failure to provide follow-up within 14 days may result in denial of reimbursement.
Mobile and telephonic follow-up contacts must be initiated within 24 hours/next business day and billed within 14 days to be eligible for Medicaid managed care reimbursement.
Claims for follow-up must use the appropriate rate code and comply with MMCO claiming processes.
Situations where challenges in daily life have resulted in, or are at risk of, escalation in psychiatric and/or substance use symptoms
Trigger for servicesBehaviors or symptoms that cannot be safely managed without immediate attention
Behavioral Health Crisis Intervention — inv-26
DefinitionActivities using therapeutic communication, interactions and supporting resources, including medication and verbal therapy, to interrupt and/or ameliorate acute BH distress and associated behaviors when immediate attention is required.
Core elementsTherapeutic communication, involvement of supports/providers, linkage to urgent psychopharmacology when needed, and safety determination/plan development
Delivery contextsUsed during telephonic triage/response, in-person mobile response, and follow-up contacts to stabilize the individual in the community
Behavioral Health Crisis Intervention Service: Qualifying Episode — inv-27
Qualifying episode startBegins with the provider's initial contact with the individual
Qualifying episode endEnds with amelioration of presenting symptoms or transfer to the recommended level of care when clinically indicated
IncludesAll discrete billable crisis response services and follow-up activities related to that episode
Collateral — inv-28
DefinitionA family/household member or other individual who regularly interacts with the recipient, is directly affected by or can affect their condition, and is identified by the recipient as having a role in treatment
RoleParticipation in evaluation and assessment prior to admission and in support of ongoing crisis interventions
IdentificationMust be identified by the recipient as necessary for participation in treatment or evaluation
Mobile Crisis Provider — inv-29
DefinitionProviders approved by NYS to be reimbursed under the 1115 Crisis Intervention Benefit to help individuals experiencing a BH episode
Approval processMust be identified by County Directors of Community Services in a County/Regional Crisis Response Plan and apply to the state for approval
Reimbursement requirementMust be an OMH-approved Mobile Crisis Provider and contract with Medicaid Managed Care plans to be reimbursed
Qualified Non-Licensed Staff — inv-30
Minimum qualificationsIndividual 18 years or older with a high school diploma or equivalent and 1-3 years relevant experience, or a bachelor's degree
Employment statusEmployed or under contract with a provider of services
Role contextUsed as qualified non-licensed staff on mobile crisis teams as specified by provider staffing plans
Safety Plan — inv-31
DefinitionAn individualized document developed collaboratively with the individual, mobile crisis staff and supports that states direct interventions during a crisis and helps anticipate/prevent future crises
ContentShould include follow-up needs, linkage to treatment, antecedents, supports, strengths, coping skills, and roles/responsibilities of participants
PurposeSupports safe community continuation and guides follow-up contacts by mobile crisis staff or identified providers
Students within approved SED programs — inv-32
DefinitionStudents and trainees participating in programs leading to recognized degrees or certificates at institutions chartered/approved by the NYS Education Department
ContextMay participate in approved SED programs while engaged in mobile crisis service delivery under supervision as allowed by program rules
IdentificationRecognized as 'Students within approved SED programs' in provider documentation and staffing plans
Up to 60 minutes (4 units) per day for telephonic follow-up/triage services
Per-diem longer responsesPer Diem billing for specified two-person S9485 responses: 90-180 minutes = 1 unit