Name of Manual - Blue Cross and Blue Shield of Minnesota

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Coding Policies and Guidelines (Behavioral Health) Code Description Units Who May Submit Misc H0013 Alcohol and/or drug services; acute detoxification (residential addiction program outpatient) H0014 Alcohol and/or drug services; ambulatory detoxification H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem H0019 Behavioral health; long-term residential (nonmedical, non-acute care in residential treatment program where stay is typically longer than 30 days), without room and board, per diem 11-72 1 per session MD, CNS-Psych, PMHNP, NP, PA, CNSmedical 1 per session MD, CNS-Psych, PMHNP, NP, PA, CNSmedical 1 per session MD, LP-PhD., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, LPCC 1 per session MD, CNS-Psych, PMHNP, PA, NP, CNS- Medical 1 per day/diem MD, LP-PhD., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, LPCC Compatible with alcohol or substance abuse dx only. Compatible with alcohol or substance abuse dx only. Compatible with alcohol or substance abuse dx only. Compatible with alcohol or substance abuse dx only. Compatible with mental health dx only. 1 per day/diem IRTS Crisis provider Compatible with mental health dx only. 1 per day/diem IRTS Crisis provider Compatible with mental health dx only. Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12
Code Description Units Who May Submit Misc H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) H0021 Alcohol and/or drug training service (for staff and personnel not employed by providers) H0022 Alcohol and/or drug intervention service (planned facilitation) H0023 Behavioral health outreach service (planned approach to reach a target population) H0024 Behavioral health prevention information dissemination service (one-way direct or nondirect contact with service audiences to affect knowledge or attitude) H0025 Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior) H0026 Alcohol and/or drug prevention process service, community-based (delivery of services to develop skills of impactors) 1 per session Freestanding Methadone/Opiod clinic, Substance Abuse Facility Coding Policies and Guidelines (Behavioral Health) 1 per session N/A Not covered 1 per session N/A Not covered 1 per session N/A Not covered 1 per session N/A Not covered 1 per session N/A Not covered 1 per session N/A Not covered Covered when provided within a methadone clinic or substance abuse facility. Compatible with alcohol or substance abuse dx only. Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-73
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
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Durable Medical Equipment Date Topi
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Medical Emergency Date Topic Change
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Rehabilitative Services Date Topic
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Table of Contents Chapter 1 At Your
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Introduction Provider Policy and Pr
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How to Contact Us At Your Service P
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At Your Service Claims Address Subm
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Care Management Numbers and Address
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Care Management Numbers and Address
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Company Phone Number Address Public
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At Your Service Provider Identifica
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ID Cards At Your Service Introducti
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Electronic Commerce Overview An imp
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Remote Access Services (continued)
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Provider Communications Provider Co
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Health Plan Members have the Follow
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Provider Agreements Participation a
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Provider Agreements Responsibilitie
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Provider Agreements Provider Number
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Provider Agreements Accounting for
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Provider Agreements Carrier Replace
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Table of Contents Chapter 3 Quality
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Quality Improvement Leadership Rati
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Quality Improvement Telephone Care:
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Quality Improvement Quality of Care
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Quality Improvement Written Policie
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Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Integrated Health Management Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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Blue Plus Member Rights and Respons
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Blue Plus Member Benefits Members
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Blue Plus Quality of Care Complaint
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Blue Plus Referral Points Remember
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Blue Plus Referral Not Required We
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Blue Plus Standing Referral Minneso
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Blue Plus Clarifications of Terms (
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Blue Plus [Date] [Name of patient]
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Blue Plus Special Member Benefits O
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Blue Plus OB/GYN Open Access Diagno
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Blue Plus OB/GYN Open Access Diagno
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BlueCard® Claim Status Inquiry ...
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BlueCard® Identifying BlueCard ®
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BlueCard® Identifying BlueCard ®
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BlueCard® BlueCard Service Claims
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BlueCard® Prior Authorization and
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BlueCard® Electronic Data Intercha
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BlueCard® Claims Processed by the
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BlueCard® Overview (continued) 3.
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BlueCard® Claim Payment Guidelines
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BlueCard® Calls from Members and O
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BlueCard® Guidelines (continued) W
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BlueCard® Types of Medicare Advant
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BlueCard® Medicare Advantage Claim
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BlueCard® Reimbursement for Medica
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Claims Filing HCPCS/ Accommodation
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Claims Filing Administrative Simpli
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Claims Filing Claims with Attachmen
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Claims Filing Claims with Coordinat
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Claims Filing Claims with Coordinat
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Claims Filing 1500 HICF Form Profes
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Claims Filing Ordering Forms and Ma
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Claims Filing Site of Service (cont
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Claims Filing Institution (837I) /F
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Claims Filing Treatment Room Blue C
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Claims Filing Single facility claim
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Claims Filing Present on Admission
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Claims Filing Medicare Crossover Bl
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Claims Filing Cancel/Void and Repla
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Claims Filing Verifying Patient Eli
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Claims Filing Basic Character Set V
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Claims Filing Rural Health Clinics
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Claims Filing Coordination of Benef
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Claims Filing TEFRA The 1982 Tax Eq
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Claims Filing Employment As defined
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Claims Filing Surgical Technicians
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Reimbursement / Reconciliation Reim
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Reimbursement / Reconciliation Comp
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Reimbursement / Reconciliation Remi
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Acco
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Reimbursement / Reconciliation Fiel
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Appeals Provider Appeals Introducti
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Appeals Submitting Requests for Pos
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Appeals Coding Appeals (continued)
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Appeals Supporting Documentation (c
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Coding Policies and Guidelines (Cod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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MH-TCM Services to Minnesota Health
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Dialectical Behavioral Therapy/DBT
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Autism Spectrum Disorder/EIBI (cont
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Coding Policies and Guidelines (Den
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Papanicolaou Smears (continued) Dia
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Coding Policies and Guidelines (Rad
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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