Are you confused by the PBHS SUD Fee Schedule? This guide simplifies the schedule for better understanding providing clarity on fees.

1. Simplifying PBHS SUD Fee Schedule For
Better Understanding
The Fee Schedule is a crucial component of the Public Behavioral Health System
(PBHS), outlining service codes and corresponding fees for healthcare
providers. The Fiscal Year (FY) 2024 PBHS Substance Use Disorder (SUD) Fee
Schedule specifically addresses Mental Health, Substance Use Disorder, and other
designated levels of care. This comprehensive guide ensures consistency and
transparency in medical billing and coding processes, streamlining reimbursement
procedures for healthcare providers.
Overview of the FY 2024 PBHS
SUD Fee Schedule:
 Service Codes and Descriptions:
The Fee Schedule comprises a detailed list of service codes, each representing a
specific healthcare service or procedure. Such service codes are accompanied by
clear and concise descriptions, aiding healthcare providers in accurately identifying
and selecting the appropriate code for each service rendered.

2.  Corresponding Fees:
Each service code is associated with a predetermined fee, indicating the
reimbursement amount allocated for that particular service. In fact, fees are
determined based on factors such as the complexity of the service, resources
required, and the overall impact on patient care.
 Levels of Care:
The Fee Schedule classifies services into different levels of care, tailoring
reimbursement rates to the intensity and complexity of each level. As a result,
healthcare providers can easily identify the appropriate level of care for a specific
service, ensuring accurate billing and reimbursement.
Important to Note:
Specific attention is given to Mental Health and Substance Use Disorder services,
reflecting the unique challenges and intricacies associated with these areas of
behavioral healthcare. Fortunately, service codes and fees are tailored to address
the diverse range of treatments and interventions required for individuals facing
mental health and substance use challenges.
Applicable Limitation:
 Maximum Units Per Day:
One critical rule stipulated in the FY 2024 PBHS SUD Fee Schedule is the limitation
on billing units per day. Providers are explicitly instructed not to bill more than 24
units per day per participant. This restriction ensures that providers do not overbill for
services, promoting fairness and preventing unnecessary financial burden on the
healthcare system.
The limitation on billing units serves as a safeguard against overutilization of
services, emphasizing quality over quantity in patient care. That’s why healthcare
providers are encouraged to focus on delivering effective and necessary treatments
rather than excessive, potentially redundant services.
Impact on Medical Billing & Coding:
 100% Reimbursement:
The Fee Schedule plays a pivotal role in determining providers’ reimbursement for
their services. Adherence to the specified service codes, fees, and unit limitations is
crucial for accurate reimbursement and financial stability for healthcare
organizations.
 Coding Accuracy and Compliance:

3. Accurate medical coding is essential for successful reimbursement. Healthcare
providers must assign the correct service codes to reflect the services provided
accurately. Compliance with the Fee Schedule guidelines is not only a financial
necessity but also a regulatory requirement, preventing potential legal and ethical
complications.
 Transparent Billing Practices:
The Fee Schedule also promotes transparency in billing practices by providing a
standardized framework for healthcare providers. Patients, payers, and regulatory
bodies can quickly review and understand the charges associated with specific
services, fostering trust in the healthcare system.
 Documentation Requirements:
To support claims and ensure compliance with the Fee Schedule, healthcare
providers must maintain comprehensive documentation of services rendered. Clear
and thorough documentation serves as a crucial tool during audits, investigations,
and reviews, validating the accuracy of billed services.
Conclusion:
The FY 2024 PBHS SUD Fee Schedule serves as a crucial roadmap for healthcare
providers, offering a standardized framework for accurate medical billing and coding
in the field of behavioral healthcare. Recognizing the intricate nature of these
services, there is a pressing need to simplify the Fee Schedule, making it more
accessible and user-friendly for healthcare providers. As compliance with the Fee
Schedule is paramount for reimbursement accuracy and overall financial stability,
providers may find relief in outsourcing medical billing and coding to specialized
companies like 24/7 Medical Billing Services.
Outsourcing not only ensures adherence to intricate guidelines but also allows
healthcare professionals to focus on delivering quality care, alleviating the
administrative burden associated with billing complexities. Ultimately, simplifying the
Fee Schedule and considering outsourcing options can enhance efficiency and
effectiveness, benefiting both healthcare providers and the individuals receiving
essential behavioral health services.
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4. Media Contact –
24/7 Medical Billing Services,
28405 Osborn Road,
Cleveland, OH, 44140
Tel: + 1 -888-502-0537
Email: info@247medicalbillingservices.com