Reminder: Blue Cross now covers in-state mental health services provided by intensive outpatient programs

Effective July 1, 2023, Blue Cross Blue Shield of Michigan will cover in-state mental health services provided through an intensive outpatient program, or IOP, as announced in a May Record article. This coverage, an enhancement to Blue Cross’ behavioral health benefits, applies to our commercial members.

Coding

Outpatient psychiatric care providers should report intensive outpatient program services for mental health using an appropriate HCPCS procedure code:

• For IOP mental health services provided in an outpatient hospital setting: Revenue codes 0905 and 0906 must be reported with an appropriate mental health diagnosis and a valid CPT/HCPCS procedure code combination.

These revenue codes are being added to the “All-Other Remainder” category for fee-based reimbursement and will follow Participating Hospital Agreement guidelines.

• For IOP mental health services provided in an approved freestanding residential hospital or outpatient substance abuse facility: Revenue code 0905 (Psychiatric) should be billed with an appropriate mental health diagnosis.

Other information

• Reimbursement for these locations will be based on an established rate.
• Mental health services for IOP admissions don’t require preauthorization.
• Benefits may vary based on group specifics.