This regulation establishes reimbursement rules for Mental Health Rehabilitation Services (MHRS) provided by DC Department of Behavioral Health certified providers, specifying billing units, service limitations, prior authorization requirements, and allowable settings for each covered service type (e.g., Diagnostic Assessment, Counseling, ACT, IDT, CBI, and others). Providers must use actual start/stop times rounded to the nearest 15-minute unit and include active NPI numbers on all claims. Service-specific restrictions prohibit same-day billing of certain service combinations and limit delivery to approved settings such as provider sites, home/community settings, or residential facilities of 16 beds or fewer.
View official source3434 REIMBURSABLE SERVICES 3434.1 Reimbursement for the provision of MHRS shall be on a per unit basis as indicated in § 3434.4. 3434.2 Each covered service shall have a unique billing code as established by the Department. 3434.3 The actual start and stop time of the service shall be used to calculate the duration of the service rounded to the nearest fifteen-minute unit. 3434.4 Reimbursement shall be limited as follows: Mental Health Rehabilitation Services (MHRS) LIMITATIONS AND SERVICE SETTING BILLABLE UNIT OF SERVICE Diagnostic Assessment One (1) every one hundred eighty (180) calendar days. Additional units allowable when there is a significant change in the consumer’s mental health status. Shall not be billed the same day as Assertive Community Treatment (ACT). Provided only in an MHRS provider’s service site, home or community setting, or residential facility of sixteen (16) beds or less unless otherwise approved by the Department. Per occurrence. Medication/ Somatic Treatment No annual limits. Shall not be billed the same day as ACT or Intensive Day Treatment (IDT). Provided only in an MHRS provider’s service site, home or community setting, via telemedicine, or in a residential facility of sixteen (16) beds or less unless otherwise stated by the Department. Session length for Individual Medication/Somatic Treatment is as follows: For new patients: Fifteen (15) to twenty-nine (29) minutes; Thirty (30) to forty-four (44) minutes; Forty-five (45) to fifty-nine (59) minutes; and Sixty (60) to seventy-four (74) minutes. For existing patients: Under ten (10) minutes; Ten (10) to nineteen (19) minutes; Twenty (20) to twenty-nine (29) minutes: Thirty (30) to thirty-nine (39) minutes; and Forty (40) to fifty-four (54) minutes. Session length for Group Medication/Somatic Treatment unit is fifteen (15) minutes. Counseling No annual limits. Shall not be billed the same day as IDT, Community Based Intervention (CBI), ACT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), or Trauma Systems Therapy (TST). Shall not be billed during a Rehabilitation Day Services encounter. Shall be rendered face-to-face, when consumer is present, unless there is adequate documentation to justify why the consumer was not present during the session. May be provided in individual on-site, individual off-site, or group setting. Provided only in an MHRS provider’s service site, home or community setting, via telemedicine, or in a residential facility of sixteen (16) beds or less unless otherwise stated by the Department. Per occurrence Community Support Prior authorization required. Shall be billed pursuant to § 3421.6. Shall not be billed on the same day as ACT. Individual Community Support shall not be billed during a Rehabilitation Day Services encounter. Group Community Support shall not be billed on the same day as Rehabilitation Day Services. Provided only in an MHRS provider’s service site, home, community setting or residential facility of sixteen (16) beds or less unless otherwise authorized by the Department. Audio-only telemedicine shall be limited to six (6) units per one hundred eighty (180) day period, unless otherwise authorized by the Department. A provider may bill an additional 20 units of audio-only for collateral contacts, per one hundred and eighty (180) day period. Fifteen (15) minutes. The District shall reimburse no more than six (6) units of service per day. Crisis/ Emergency Services No annual limits. ACT providers shall not bill Crisis/Emergency Services when provided to one of their current consumers. Provided only in an MHRS provider’s service site, home or community setting or via telehealth. Provided by a Core Service Agency to their enrolled consumers. Fifteen (15) minutes Rehabilitation Day Services Prior authorization required. Two hundred seventy (270) units within a one hundred eighty (180) day period. Additional units require supplemental authorization from the Department. Each subsequent authorization shall not exceed two hundred and seventy (270) units within a one hundred and eighty (180) day period. Shall not be billed on the same day as Group Community Support, IDT, TF-CBT, Trauma Recovery and Empowerment Model (TREM), TST, or Clubhouse. Shall not be billed during a Counseling or Individual Community Support encounter. Provided only in an MHRS provider’s service site. One (1) hour. The District shall not reimburse more than six (6) hours of service per day. IDT Prior authorization required. Initial and subsequent authorizations shall not exceed seven (7) days at a time. Shall not be billed on the same day as Medication/Somatic Treatment, Counseling, Rehabilitation Day Services, ACT, TF-CBT, TREM, TST, Clubhouse, or Supported Employment Services as defined in Title 22-A DCMR Chapter 37. Provided only in an MHRS provider’s service site. One (1) day (which shall consist of at least five (5) hours of IDT services, excluding appropriate time for breaks and administrative functions) CBI Prior authorization required for enrollment and continued stay (see § 3425 for details). Shall not be billed on the same day as Counseling, ACT, FFT, or TF-CBT. CBI Level II and III shall not be billed on the same day as TREM. Provided only in an MHRS provider’s service site, or home or community setting. Fifteen (15) minutes ACT Prior authorization required. Initial and subsequent authorizations shall not exceed six (6) calendar months. Shall not be billed on the same day as Diagnostic Assessment, Medication/Somatic Treatment, Counseling, Community Support, IDT, CBI, FFT, TF-CBT, TREM, or TST. ACT providers shall not bill Crisis/Emergency Services if provided to one of their current consumers. ACT providers must deliver five (5) contacts per calendar month as defined in § 3426.19 and meet the requirements of § 3426.20 through § 3426.22 to receive the monthly rate. Monthly rate Child-Parent Psychotherapy (CPP) May be provided without prior authorization. Shall not be billed on the same day as TF-CBT or TST. Provided only in an MHRS provider’s service site, home or community setting or residential facility of sixteen (16) beds or less unless otherwise approved by the Department. Fifteen (15) minutes up to ninety (90) minutes once (1) per week TF-CBT May be provided without prior authorization. Shall not be billed on the same day as Counseling, Rehabilitation Day Services, IDT, CBI, FFT, ACT, CPP, or TST. Provided only in an MHRS provider’s service site, home or community setting, or residential facility of sixteen (16) beds or less unless otherwise approved by the Department. Fifteen (15) minutes up to ninety (90) minutes once (1) per week TREM May be provided without prior authorization. TREM shall not be billed on the same day as Rehabilitation Day Services, IDT, CBI Levels II and III, or ACT. Provided only in an MHRS provider’s service site, or residential facility of sixteen (16) beds or less unless otherwise approved by the Department. Fifteen (15) minutes TST May be provided without prior authorization. TST shall not be billed on the same day as Counseling, Rehabilitation Day Services, IDT, FFT, ACT, CPP, or TF-CBT. Fifteen (15) minutes FFT May be provided without prior authorization. Shall not be billed on the same day as CBI, Community Support, TF-CBT or TST. Fifteen (15) minutes Clinical Care Coordination (CCC) No annual limits. May be provided without prior authorization. ACT providers shall not bill CCC when provided to one of their current consumers. May be provided in an MHRS provider’s service site, home or community setting, or via telehealth. A provider may only claim one service if multiple clinicians from that provider agency participate in the CCC service. Fifteen (15) minutes Intensive Care Coordination (ICC) Prior authorization required. May be provided at the ICC provider’s service site; or in natural settings, including at the child/youth’s home or community settings; or at an out-of-home placement where the child/youth is pending discharge to the community. Monthly rate 3434.5 All claims seeking Medicaid or local only reimbursement under this Chapter shall include the active NPI numbers for the certified provider and the rendering provider. The rendering provider is the staff member who provided the service. SOURCE: Final Rulemaking published at 70 DCR 003050 (March 10, 2023); corrected by Errata Notice published at 70 DCR 014191 (October 27, 2023); as amended by Final Rulemaking published at 70 DCR 016660 (December 29, 2023); as corrected by Errata Notice published at 71 DCR 004474 (April 19, 2024); as amended by Final Rulemaking published at 72 DCR 002797 (March 14, 2025); as amended by Final Rulemaking published at 72 DCR 008497 (August 1, 2025); as amended by Final Rulemaking published at 72 DCR 014041 (December 19, 2025); as amended by Final Rulemaking published at 73 DCR 007822 (May 22, 2026). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 3434