Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
Rule 29 Setting State licensed Rule 29 clinics will have three provider numbers:
Day Treatment H2012
One for services in the clinic
One for MD/Psychiatrists to bill for inpatient services
One for Ph.D. level psychologists to bill for inpatient services
Services should be billed under the appropriate provider number or
NPI.
Rule 29 clinics can only provide outpatient mental health services
under this licensure. Any inpatient services billed under the Rule
29 clinic provider number or NPI will be denied. Some Rule 29
clinics will also be licensed as nonresidential chemical dependency
providers. It is important to keep these two entities separate.
If a patient is being treated for depression secondary to a chemical
dependency, the depression diagnosis should be billed as the
primary diagnosis under the Rule 29 clinic provider number or
NPI.
When non-licensed practitioners treat patients, their services
MUST be billed under the supervising practitioner’s individual
provider number and with the U7 modifier or NPI.
Behavioral health day treatment services may be provided at a
licensed Rule 29 facility. Day treatment is a specific
programmatic service where the patient attends a minimum of
3 hours per day and generally 3-5 hours per day, 3-5 days per
week. The services provided within these hours may include
group therapy, living/social skills building groups, educational
groups, and some individual time.
Day treatment is billed as a program, rather than under an
individual provider. Bill one line for each day and one unit for
each hour the patient attends the program.
Services are reimbursed under the member’s outpatient mental
health benefits.
Compatibility This is a very common and frequent cause for claim denials. The
diagnosis code and CPT code must be compatible as well as
compatible with the practitioner’s licensure.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-43