How to Add Procedure Rates for Hospital Discharge Management

CalMHSA has added a new procedure code called ‘Hospital Discharge Day Management. Counties will need to add rates into SmartCare for this code.

To perform this activity it will be necessary to be logged into SmartCare as well as having the SMHS and DMC Fee schedules available.

Downloading the SMHS Fee Schedule

Go to DHCS’s website: Medi-Cal Behavioral Health Fee Schedules
Click on the hyperlink to download the applicable Fee Schedule. This procedure can be performed for both DMC and SMHS service areas.
To locate the rate schedules, click on the links for ‘SMHS Outpatient Rates’ and ‘DMC ODS Outpatient’ or ‘DMC County Outpatient’ to open the corresponding spreadsheet.

Use the filters at the top of the spreadsheet to navigate to your county and filter by procedure codes 99238 and 99239:

Leave this spreadsheet open as it will be used in later steps

Adding the Procedure Rates into SmartCare

Select either the MH or DMC fee schedule to start with and then bring up SmartCare.

Within SmartCare, click on the Search icon.
Type “Procedure” in the search bar.
Select “Procedure /Rates (Administration)” from the search results.

This will bring up the Procedure/ Rates list page. Enter ‘Hospital Discharge’.
Click Apply Filter.
Click on the hyperlink found in the Procedure column.

Click on the ‘Rates/Billing Codes’ Tab
Set the From date to ‘07/01/2023’
Enter the rate amount as specified in the Fee Schedule
Select ‘Range’ from the dropdown
Enter the From Units
1. If the rate is for billing code 99238 then enter a 1 in the From Units
2. If the rate is for billing code 99239 then enter a 31 in the From Units

Enter the To Units
1. If the rate is for billing code 99238 then enter a 30 in the To Units
2. If the rate is for billing code 99239 then enter a 1440 in the To Units
Click the Degrees button and in the dialog box that appears select the degrees that correspond to the Degree Group listed in the Fee Schedule
Click on the Service Areas button and select either ‘MH or ‘DMC’ based off the rate being inserted

Enter the Billing Code and click Insert

The Coverage Plans popup should appear. Select ‘Medi-Cal MH’ and/or ‘Medi-Cal DMC’
Click Save and Close.

Click Save in the upper right corner.
Repeat the steps above for each degree group listed in the fee schedule for the 99238 and 99239 Billing codes.

Adding the Procedure Rates into SmartCare for a Medical Resident/ACGME Fellow Degree

If a Medical Resident will be performing these services within your county, additional rate records will need to be entered for the MH and DMC services areas containing the GC Modifier.

Set up the rate records as specified above but with the following adjustments:

In the Degree button select ‘Medical Resident/ ACGME Fellow’