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PAP908

Follow-up After Hospitalization for Mental Illness Incentive


Provider Administrative Policy

Section
Behavioral Health
Policy Date
January 2014
Status/Date
New/January 2014
Provider Type(s)
Mental Health  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Follow-up After Hospitalization for Mental Illness Incentive

Blue Cross of Idaho is committed to helping improve the quality of care and services available to our members by promoting effective and efficient use of healthcare resources. One way we do this is by aligning provider reimbursement with measures that reduce administrative or medical costs for our members. The intent of this policy is to establish reasonable and consistent quality requirements for behavioral health providers, and to incentivize follow-up services for members discharged from an inpatient psychiatric hospital.

This incentive has been created in an effort to minimize unnecessary readmission into an in-patient setting. Modifier SC has been added to the behavioral health fee schedule with an additional allowance to the following procedure codes: 90791, 90832, 90834, and 90837. This policy is effective for all behavioral health providers that meet the criteria establishing herein including:

  • Psychologist
  • LCPC, LCSW

Behavioral health providers will be reimbursed per the member benefits in addition to a standard psychiatric evaluation if the following criteria are met:

  • A contracted provider submits a standard CMS 1500 claim form billing or its electronic equivalent that include a covered psychotherapy CPT code 90791, 90832, 90834, or 90837 with modifier SC.
  • Date of service must be within 7 days of discharge from an in-patient psychiatric hospital.

Additional Information:

  • The member can select any contracted professional provider type listed above according to the member's benefit plan for behavioral health services.
  • Qualifying claims will be based on the discharge date from the in-patient hospital stay.
  • Claims submitted with date of service greater than 7 days from the date of discharge will not be eligible for the additional payment.

Policy History

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