Community Violence Prevention (CVP) services reimbursement
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Defines proposed changes to Maryland Medicaid's CVP benefit including unit of service, provider affiliation requirements, reimbursement rate and annual limits for Medicaid participants exposed to community violence or treated for related injuries.
The unit of service for CVP benefits is changing to 15-minute increments.
Provider specifications are updated to require affiliation with at least one hospital.
A reimbursement rate of $16.38 per 15-minute unit is established.
A maximum of 200 units per 12-month period is established.
CVP Coverage Criteria (Proposed)
CVP coverage criteria (proposed)
Coverage for CVP services under Maryland Medicaid is conditioned on the following:
ALL of the following
ALL of the following
- Medicaid participant who has been exposed to community violence or has received treatment for an injury sustained as a result of an act of community violence.
ALL of the following
- Services are provided by a certified violence prevention professional.
- Provider entity maintains an affiliation with at least one hospital through which the provider is authorized to provide CVP services to Medicaid members (hospital need not be a designated trauma center).
ALL of the following
- Service is recommended by a physician or other qualified licensed practitioner of the healing arts within the practitioner’s scope of practice under state law (per 42 C.F.R. § 440.130(c)).
ALL of the following
- Reimbursed at $16.38 per 15-minute unit.
- Maximum of 200 units per 12-month period.
ALL of the following
- Proposed effective date of October 1, 2026.
Billing Units, Limits, and Rates
| No codes listed |
Provider Requirements and Actions
Recommendation must come from an authorized practitioner
CVP services must be recommended by a physician or other qualified licensed practitioner of the healing arts within the practitioner's scope of practice under state law.
Maintain hospital affiliation to provide CVP services
Providers must maintain an affiliation with at least one hospital through which the provider entity is authorized to provide CVP services to Medicaid members in the hospital.
Definitions
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