Revised Behavioral Health Specific Billing …

1 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.

2 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.

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.)

4 CPT Code Description 96150 Health and behavior assessment ( , Health -focused clinical interview, Behavioral observations, psychophysiological monitoring, Health -oriented questionnaires, each 15 minutes face-to-face with the patient; initial assessment. 96151 Health and behavior assessment ( , Health -focused clinical interview, Behavioral observations, psychophysiological monitoring, Health -oriented questionnaires, each 15 minutes face-to-face with the patient; re-assessment. 96152 Health and behavior intervention, each 15 minutes, face-to-face; individual. 96153 Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients). 96154 Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present).))

5 96155 Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present). 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: service may be: Emergency Room performed only by psychiatrist and billed according to contract fee schedule Hospital Bed performed by psychiatrist and/or psychologist and billed according to contract fee schedule Nursing Home 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.

6 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 Acute Care, Inpatient Hospital, A&D Detox 0118, 0128, 0138, 0148, 0158 Acute Care, Inpatient Hospital, Substance Abuse Disorder 1001 Non-Acute, Residential Treatment, Psychiatric Non-Acute, Residential Treatment, Eating Disorder Hospitalization 23-Hour Observation, Substance Abuse Disorder 1002 Non-Acute, Residential Treatment, Substance Abuse Disorder 1004 Supervised Living, Substance Abuse Disorder, Half-Way House Supervised Living, Mental Health , Half-Way House 0901 ECT Inpatient and Outpatient 0905 Intensive Outpatient, Psychiatric Intensive Outpatient, Eating Disorder 0906 Intensive Outpatient.

7 Substance Abuse Disorder 0912, 0913 Partial Hospital, Psychiatric (Day Treatment) Partial Hospital, Substance Abuse Disorder (Day Treatment) Partial Hospital, Eating Disorder 0944 Methadone Detox 0944, 0945 Ambulatory Detox 0910 Crisis Stabilization 0944. 0529 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. 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.