Behavioral Health Specific Billing Guidelines The following information is intended to assist you when billing behavioral health professional and facility claims. For general claims filing instructions, please refer to Section VI. Billing and Reimbursement in this Manual.
1. Inpatient Professional Services Inpatient professional behavioral health services must be filed on a CMS1500 (HCFA-1500) claim® form using the most appropriate Current Procedural Terminology (CPT ) code. When submitting ANSI 837 electronic claims, the Professional format must be used (ANSI 837P). ®
The following billable services list represents the most frequently utilized CPT codes for inpatient professional services:
2. Outpatient Professional Services Outpatient professional behavioral health services must be filed on a CMS1500 (HCFA® 1500) claim form using the most appropriate Current Procedural Terminology (CPT ) code. When submitting ANSI 837 electronic claims, the Professional format must be used (ANSI 837P). ®
Behavioral health professionals may only provide services and bill for CPT codes that fall within the scope of practice allowed by their professional training and state licensure. The ®
following billable services list represents the most frequently utilized CPT codes for outpatient professional services: CPT® Code 90801
90813
90826
90802
90814
90827
90880
90804
90815
90828
90901
90805
90816
90829 96101 96103
90806
90817
90846
99058
90807
90818
90847
99212
90808
90819
90849
99241
90809
90821
90853
99242
90810
90822
90857
99243
90811
90823
90862
99244
90812
90824
90870
99245
3. Health and Behavior Assessment/Intervention Performance of a health and behavior assessment may include a health-focused clinical interview, behavioral observations, psychophysiological monitoring, use of health-oriented questionnaires, and assessment data interpretation. Elements of a health and behavior intervention may include cognitive, behavioral, social, and psychophysiological procedures that are designed to improve the patient’s health, ameliorate specific disease-related problems, and improve overall well being. ®
Effective January 1, 2002, the following CPT codes should be billed with a medical diagnosis: (Please refer to the current International Classification of Diseases (ICD) Codes manual for the most appropriate diagnosis code in effect for the date of service.) CPT® Code
Description
96150
Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires, each 15 minutes face-to-face with the patient; initial assessment. Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires, each 15 minutes face-to-face with the patient; re-assessment. Health and behavior intervention, each 15 minutes, face-to-face; individual. Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients). Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present). Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present).
96151
96152 96153 96154 96155
4. Psychiatric Consultation Guidelines in a Medical Setting When psychiatric consultation services are required, Providers should call the Behavioral Health number on the back of the member’s ID card to verify member eligibility and determine prior authorization requirements. If prior authorization IS required, the call will be transferred to abehavioral health case manager. Inform the case manager you are requesting prior authorization for a consultation service for a patient who is receiving medical treatment on a medical unit/floor, in an emergency room or in a nursing home. If prior authorization is NOT required, the following guidelines apply:
If consultation is in: Emergency Room Hospital Bed Nursing Home
service may be: performed only by psychiatrist and billed according to contract fee schedule performed by psychiatrist and/or psychologist and billed according to contract fee schedule performed by all behavioral health professionals and billed according to contract fee schedule
Psychiatric consultation services must be billed with the appropriate Place of Service ®
code for the medical treatment setting and the CPT code provided at the time the service was authorized. Claims must be billed on a CMS-1500 claim form or ANSI 837 professional transaction. 5. Facility and Program Services Revenue Codes As a result of the code set requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), behavioral health facility claims must be filed with the appropriate Revenue Codes in accordance with your Magellan Behavioral Health Provider Participation Agreement for BlueCross BlueShield of Tennessee business. A listing and contract descriptions follow: Revenue Code
Contract Description
0116, 0126, 0136, 0146, 0156, 0204 0118, 0128, 0138, 0148, 0158 1001
Acute Care, Inpatient Hospital, A&D Detox
1002 1004 0901 0905 0906 0912, 0913
0944 0944, 0945 0910 0944. 0529
Acute Care, Inpatient Hospital, Substance Abuse Disorder Non-Acute, Residential Treatment, Psychiatric Non-Acute, Residential Treatment, Eating Disorder Hospitalization 23-Hour Observation, Substance Abuse Disorder Non-Acute, Residential Treatment, Substance Abuse Disorder Supervised Living, Substance Abuse Disorder, Half-Way House Supervised Living, Mental Health, Half-Way House ECT Inpatient and Outpatient Intensive Outpatient, Psychiatric Intensive Outpatient, Eating Disorder Intensive Outpatient, Substance Abuse Disorder Partial Hospital, Psychiatric (Day Treatment) Partial Hospital, Substance Abuse Disorder (Day Treatment) Partial Hospital, Eating Disorder Methadone Detox Ambulatory Detox Crisis Stabilization Methadone Maintenance (Not a covered service in all plans)
To avoid delays in receiving payments, behavioral health claims should be submitted to the following address: BlueCross BlueShield of Tennessee, Inc. P.O. Box 180150 Chattanooga, TN 37402
HIPAA Information about ICD-9 Codes HIPAA requires that the diagnostic code set used on claim submissions must be codes from the ICD-9 Code manual.
