Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
Opioid Maintenance
Drug Therapy
(continued)
11-42
Buprenorphine administration is a professional service that
should be billed on an 837P claim format. This charge will
deny if incorrectly submitted on an 837I. When administered
as part of a program, procedure code H0047 (along with a
narrative stating this is for buprenorphine) should be billed
with diagnosis code 304.01. When administered in the office,
the appropriate office visit or evaluation management
procedure code should be billed with diagnosis code 304.01.
Buprenorphine administration applies to the member’s
substance abuse benefits for office visits, and these charges
will not be applied to any accumulation maximums for the
member. The injectable form of buprenorphine hydrochloride
should be billed as code J0592 with one unit per 0.1 mg
dosage.
Tobacco Cessation Submit diagnosis code 305.1 or V15.82 if the intent is
counseling and/or visit to obtain a prescription for smoking
cessation medication/patches.
If linked to an E/M service, a preventative or general illness
benefit will be applied depending on the member’s benefits.
Do not use 305.1 or V15.82 as the primary diagnosis if the
member has a primary behavioral health diagnosis (such as
depression) that is being treated but the member also uses
tobacco. If this is the case, 305.1 or V15.82 should be listed as
a secondary diagnosis.
Hypnotherapy (code 90880), biofeedback (codes 90875-
90876), and acupuncture (codes 97810- 97811, 97813-97814)
are considered investigative for treatment of tobacco use,
dependence, and withdrawal, and are ineligible for
reimbursement.
Nicotine replacement therapies and bupropion for the treatment
of tobacco dependence are subject to the member’s pharmacy
benefits.
Coverage for the treatment of tobacco dependence is subject to
the member’s contract benefits.
Any inpatient treatment service for tobacco cessation should be
prior authorized, as they will be reviewed for medical
necessity.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12