BH Medicare Advantage Billing — 2026 Guide

MA vs Original Medicare Differences

• MA plans have contractual authority (can require prior auth)
• MA plans have network requirements
• MA plans include Part B + Part D + often supplemental
• MA plans have Star Rating incentive on quality metrics

HCC Risk Adjustment for BH

• Depression HCCs: 155, 156 (single vs combined)
• Bipolar HCCs: 152
• Schizophrenia HCCs: 152
• Substance Use HCCs: 55, 56
• Anxiety not typically HCC-eligible

Documentation Requirements

1. Annual MEAT assessment (Monitored, Evaluated, Assessed, Treated)
2. DSM-5-TR specific diagnosis
3. Severity indicator (mild/moderate/severe)
4. Response to treatment documentation

MHPAEA Parity for MA

• MA plans MUST comply with MHPAEA parity
• Same enforcement as commercial (DOL + HHS + Treasury)
• Appeal rights preserved

Revenant Care MA Expertise

– KD, Revenant Care