Behavioral health providers: How to bill prolonged services

In January 2023, we posted a provider alert that asked behavioral health providers to hold claims for dates of service on or after Jan. 1, 2023, that contain procedure codes *99354 and *99355. These codes were for prolonged services and were terminated by the American Medical Association as of Jan. 1, 2023.

At that time, we indicated that we were working on identifying active codes to bill in place of the terminated codes.

What to do with claims you’ve been holding

• For Blue Cross Blue Shield of Michigan and Blue Care Network commercial members, use HCPCS code G2212 in place of procedure codes *99354 and *99355 for dates of service on or after Jan 1, 2023. The G2212 code can now be billed with procedure codes *90837 and *90847.
• For Medicare Plus Blue℠ and BCN Advantage℠ members, follow the Centers for Medicare & Medicaid Services billing guidelines.

Additional information and reminders

• HCPCS code G2212 is billed in increments of 15 minutes for each unit of prolonged service after the time of the base code is exhausted.
• You can submit claims with G2212 for dates of service as early as Jan. 1, 2023.
• Any claims for dates of service on or after Jan. 1, 2023, that contain codes *99354 and *99355 will be rejected, even if the claims also contain codes that are payable.  
• Claims with dates of service prior to Jan. 1, 2023, can still be billed with procedure codes *99354 and *99355.