Name of Manual - Blue Cross and Blue Shield of Minnesota

Code Description Units Who May Submit Misc
H2032 Activity therapy, per 15 minutes 1 per 15
minutes
MD, LP-Ph.D., LP-MA, LICSW, CNS-
Psych, PMHNP, LMFT, PA, NP, LPCC
Coding Policies and Guidelines (Behavioral Health)
Not covered
H2033 Multisytemic therapy for juveniles 1 per session N/A Generally not covered
H2034 Alcohol and/or drug abuse halfway house
services, per diem
H2035 Alcohol and/or other drug treatment program,
per hour
H2036 Alcohol and/or other drug treatment program,
per diem
H2037 Developmental delay prevention activities,
dependent child of client, per 15 minutes
M0064 Brief office visit for monitoring or changing
drug prescriptions
S3005 Performance measurement, evaluation of
patient self assessment, depression
1 per day N/A Not covered
1 per hour N/A Not covered
1 per day N/A Not covered
1 per 15
minutes
N/A Not covered
1 per session MD, CNS-Psych, PMHNP, PA, NP Compatible with BH dx
only
1 per session N/A Not covered
S8940 Equestrian/hippotherapy, per session 1 per session N/A Not covered
S9475 Ambulatory setting substance abuse treatment
or detoxification services, per diem
S9480 Intensive outpatient psychiatric services, per
diem
S9482 Family stabilization services, per 15 minutes 1 per 15
minutes
1 per day MD, LP-Ph.D., LP-MA, LICSW, CNS-
Psych, PMHNP, LMFT, LPCC
1 per day MD, LP-Ph.D., LP-MA, LICSW, CNS-
Psych, PMHNP, LMFT, PA, NP, LPCC
Compatible with CD dx
only
Compatible with BH dx
only
N/A Not covered
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-79