Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
Non-Residential
Treatment Centers
FEP Exclusion of
Residential Treatment
Centers
11-90
State licensed non-residential treatment centers generally only bill
outpatient chemical dependency services. A limited number of
mental health services will be covered in this setting.
Some non-residential treatment centers are dually licensed as both
a Rule 29 clinic and a residential treatment center. It is important
to bill appropriate services under each separate entity. Mixing
services and provider specialties may cause a claim to deny.
The Federal Employee Program (FEP) benefits specifically
exclude services billed or provided by a residential treatment
center (RTC). To access the 2011 Service Benefit Plan brochure
go to fepblue.org and the information is currently available on
pages 70 and 86 regarding the RTC exclusion. Affected providers
include all mental health and substance abuse RTCs.
All Federal Employee Program members have been notified that
RTCs are not covered providers. Blue Cross will work with these
members through the case management team to ensure they
continue to receive medically necessary and cost-effective
treatment.
Compatibility Compatibility is a frequent and common cause of claim denials.
Recreational Therapy 0941
Revenue code 0944 should only be billed with a chemical
dependency diagnosis code.
Revenue Code 0945 should only be billed with an alcohol
dependency diagnosis code.
Recreational therapy may be part of an approved CD outpatient
program. It is included under the CD program charges and should
not be billed separately under revenue code 0941.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12