Name of Manual - Blue Cross and Blue Shield of Minnesota

Code Description Units Who May Submit Misc
T2022 Case management, per month 1 per calendar
month
T2023 Targeted case management; per month 1 per calendar
month
T2024 Service assessment/ plan of care
development, waiver
T2025 Waiver services; not otherwise specified
(NOS)
Coding Policies and Guidelines (Behavioral Health)
N/A Generally not covered
Approved MH Center, BH Clinic,
Community MH Center, CNS – Psych,
LICSW, LP-PhD, LP – MA, LMFT,
PMHNP, LPCC, Social Service Agency
DIAMOND project only
PMAP/MNCare only
1 per session N/A Not covered
1 per session N/A Not covered
T2026 Specialized childcare, waiver; per diem 1 per day N/A Not covered
T2027 Specialized childcare, waiver; per 15 minutes 1 per 15
minutes
T2028 Specialized supply, not otherwise specified,
waiver
T2029 Specialized medical equipment, not otherwise
specified, waiver
T2030 Assisted living; waiver, per month 1 per calendar
month
N/A Not covered
1 per session N/A Not covered
1 per session N/A Not covered
N/A Not covered
T2031 Assisted living; waiver, per diem 1 per day N/A Not covered
T2032 Residential care, not otherwise specified
(NOS), waiver; per month
T2033 Residential care, not otherwise specified
(NOS), waive; per diem
1 per calendar
month
N/A Not covered
1 per day N/A Not covered
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-83