Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
Health and Behavior
Assessment and
Intervention Codes
11-44
96150-96155
Codes 96150-96155 are eligible to be billed by all behavioral
health practitioners. However, per CPT, 96150-96155 describe
services offered to patients who present with established illnesses
or symptoms, are not diagnosed with mental illness, and may
benefit from evaluations that focus on biopsychological factors
related to the patients’ physical health status. The primary
diagnosis for the claim line containing these assessment and
intervention codes should be a non-behavioral health diagnosis
code. (An example would be a newly diagnosed cancer patient or a
patient struggling with infertility.)
Missed Appointments Missed scheduled appointments are not paid for by Blue Cross.
Blue Cross recommends that your clinic establish a uniform
cancellation policy requiring 24-hour advance notification. Your
clinic may bill a patient who misses a scheduled behavioral health
appointment, provided that you have notified the member in
writing in advance that this is your policy. A copy of this signed
notification should be maintained in your patient’s medical record.
Your patient should be billed no more than your contracted rate.
Government programs such as Prepaid Medical Assistance
(PMAP), MinnesotaCare and Medicare prohibit billing for missed
appointments.
This policy applies to providers, whose scope of practice is
behavioral health, including psychiatrists, licensed psychologists
(LP), licensed independent clinical social workers (LICSW),
licensed marriage and family therapists (LMFT), registered nurse
clinical specialist (CNS) and out-patient chemical dependency
(OPCD) facilities. This policy change is not intended to apply to
medication management provided within the member’s primary
care clinic or internist’s office.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12