0810.010.15.15.10 Identifying DMH Medical Services Allowable for Spend Down – DSS Manuals
IM-27 March 16, 2012
The four types of DMH medical services that are not covered by Medicare or other third-party insurance and are allowable towards a participant’s spend down can be identified through the provider type, designated by the first two digits of the Medicaid provider number.
Each is billed using a provider type that is specific to the services:
87 – Community Psychiatric Rehabilitation (CPR)
86 – Comprehensive Substance Abuse Treatment and Rehabilitation (CSTAR)
85 – Developmentally Disabled 1915(c) waiver services
15 – Targeted Case Management (TCM) for Individuals with Developmental Disabilities (DD), for adults with Serious Mental Illness (SMI), and for children with a Severe Emotional Disturbance (SED)
Missouri Department of Mental Health: Locating Treatment & Services