During the 2024/2025 fiscal year, the Department of Health Care Services (DHCS) revised its billing guidance on how to extend non-E&M therapy service codes by introducing substitute therapy codes of T2021 and T2024. These ‘T codes’ allow clinicians to be reimbursed for the total time spent with a client by incrementing for every 15 minutes beyond the max allowed time allowed for the CPT code.
The Invoice Generator is designed to pull the initial charge associated with a service into the Contract Provider Charge Export. This logic may result in contractors being underpaid for this subset of billing codes if the charge appearing in the export is for one of these codes, the payer tied to the charge is Medicare or an OHC plan, and the service duration exceeds the allowed minutes associated with the CPT code.
To address this scenario, CalMHSA has implemented the following changes to the Invoice Generator.
Invoice Generator
- Settings Tab: A new tab named ‘Settings’ has been added to each of the Invoice Generators. This tab displays the list of non-E&M therapy service codes. The column labeled ‘Max Duration for CPT’ indicates the maximum number of minutes allowed per CPT code. Services exceeding this duration will generate the appropriate T code based on the ‘T code’ column.
- Rate Type Dropdown: Below the list of CPT codes, there is a dropdown selection for Rate Type. The default selection is ‘Standard,’ which applies the existing logic to the Invoice Generator. The second option is ‘Standard & Commercial.’
- When ‘Standard & Commercial’ is selected, the Invoice Generator will use new logic to calculate rates. It will convert CPT codes to T2021 or T2024 if the maximum duration for the CPT code is exceeded. In addition, the charge units will increment one unit for every 15 minutes of the service duration.
- Outpatient 2425_Commerical Rates Tab: A new tab named ‘Outpatient Rates 2425_Commercial’ reflects the rates for this subset of CPT codes if rates need to be edited for these CPT codes. This tab will automatically pull and calculate the rate amount for each CPT and T code based on the hourly rate for the Degree Group the clinician is associated with.
- Invoice Detail Tab: If the Invoice Generator converts one of the CPT codes to a T2021 or T2024, the conversion and number of charge units will reflect under the ‘Invoice Detail’ tab.
- Last Updated: April 22, 2025