Name of Manual - Blue Cross and Blue Shield of Minnesota

Code Description Units Who May Submit Misc
99281-
99285
Emergency department E/M 1 per session MD only
99408 Alcohol and/or substance (other than tobacco)
abuse structured screening (e.g., AUDIT,
DAST), and brief intervention (SBI) services;
15 to 30 minutes
99409 Alcohol and/or substance (other than tobacco)
abuse structured screening (e.g., AUDIT,
DAST), and brief intervention (SBI) services;
greater than 30 minutes
G0175 Scheduled interdisciplinary team conference
(minimum of three exclusive of patient care
nursing staff) with patient present
G0176 Activity therapy, such as music, dance, art or
play therapies not for recreation, related to the
care and treatment of patient’s disabling
mental health problems, per session (45
minutes or more)
G0177 Training and educational services related to
the care and treatment of patient’s disabling
mental health problems per session (45
minutes or more)
1 per session MD, LP-PhD, LP-MA, LICSW, CNS-
Psych, PMHNP, LMFT, LPCC
1 per session MD, LP-PhD, LP-MA, LICSW, CNS-
Psych, PMHNP, LMFT, LPCC
Coding Policies and Guidelines (Behavioral Health)
Compatible with alcohol or
substance abuse dx only.
Compatible with alcohol or
substance abuse dx only.
1 per session N/A Denied. If IP or partial
hospital - part of hospital
rates. Not payable as OP
therapy code – no medical
necessary care is provided.
1 per session N/A Denied. If IP or partial
hospital - part of hospital
rates. Not payable as OP
therapy code – no medical
necessary care is provided.
1 per session N/A Denied. If IP or partial
hospital - part of hospital
rates. Not payable as OP
therapy code – no medical
necessary care is provided.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-69