Name of Manual - Blue Cross and Blue Shield of Minnesota

DIAMOND Initiative
(continued)
Reimbursement
Coding Policies and Guidelines (Behavioral Health)
Only those primary care providers who have been certified or
approved by ICSI, who have been trained in the DIAMOND care
model, who have been contacted by Blue Cross, and who have
elected to participate in the DIAMOND Initiative will be eligible
for reimbursement. The Blue Cross allowed amount will be up to
$100 plus applicable MinnesotaCare tax for eligible members and
eligible providers up to a maximum of 12 consecutive months per
member.
Marital Counseling Diagnosis code V61.10, counseling for marital and partner
problems, unspecified.
Generally, marital counseling is a contract exclusion for
members and will deny as member responsibility when this
diagnosis code is used as the primary diagnosis. Relationship
improvement/enhancement services or training not related to
the treatment of a diagnosable mental health disorder are
generally not covered.
Opioid Maintenance
Drug Therapy
Opioid treatment will be processed at the member’s highest
benefit level if there is coverage for these services in the
member’s contract benefits. No referral is required for Blue
Plus members. If a member’s contract has no substance abuse
benefits or if a member’s contract has methadone and/or
buprenorphine treatment as a contract exclusion, then there is
no coverage for these services.
Only providers that are contracted as a freestanding methadone
clinic can bill methadone treatment services.
The participating freestanding opioid treatment clinics
methadone administration is a professional service that should
be billed on an 837P claim format with procedure code H0020
and diagnosis code 304.01. This charge will deny if incorrectly
submitted on an 837I. This service is treated as medication
management so will not be counted against any substance
abuse accumulation maximums for the member.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-41