Clarification: Billing for IOP services provided via telemedicine for some members

We originally communicated about this in a November 2021 Record article. The information in this article is intended to clarify billing instructions for intensive outpatient program, or IOP, services provided via telemedicine.

For behavioral health IOP services provided via telemedicine with dates of service on or after Oct. 1, 2021, bill revenue code 0905 or 0906, the applicable procedure code and modifier GT or 95. We use these modifiers to identify IOP services that are delivered via telemedicine.

Follow this guidance when billing for behavioral health IOP services provided to Blue Cross commercial, BCN commercial and BCN Advantage℠ members via telemedicine. For information about billing IOP services provided to Medicare Plus Blue℠ members via telemedicine, follow guidance from the Centers for Medicare & Medicaid Services.

Keep the following in mind:

• For Blue Cross commercial members, most plans don't cover IOP services for mental health disorders. IOP services for substance use disorders must be delivered by a substance abuse treatment facility. Be sure to check member eligibility and benefits before performing services.
• Facilities can provide IOP services to BCN commercial and BCN Advantage℠ members only when their contracts specifically include IOP services.

We’ve updated the following documents to reflect this change:

• Telehealth for behavioral health providers
• Billing tips for COVID-19 at a glance

You can find these documents on our public website at bcbsm.com/coronavirus or within Provider Secured Services.

Note: For Medicare Plus Blue members, see the Medicare-covered telehealth services for the COVID-19 PHE document to determine which IOP procedures codes are billable for telemedicine.