Medicare AdvantageDocumentationMedium impact
Consider Behavioral Health Evaluations During Hospital Stays
BCBS New Mexico·NM · Psychiatry, Internal Medicine, Family Medicine +2 more·General
Effective date
Aug 19, 2026
We identified it
Aug 20, 2026
Summary
This new policy encourages hospitals to conduct behavioral health evaluations for members admitted for physical health conditions who exhibit behavioral health symptoms, with follow-up care within 30 days post-discharge. When psychiatric consultations result in secondary behavioral health diagnoses, billing teams must include the behavioral health diagnosis and appropriate psychiatric E/M CPT codes on claims.
Action Required
Effective immediately (policy dated Aug 19, 2026): Billing team must ensure that when members receive psychiatric consultations during medical inpatient stays and receive secondary behavioral health diagnoses, claims include: (1) the behavioral health diagnosis code(s), and (2) the correct psychiatric E/M CPT code (99221-99223 for initial evaluations or 99231-99233 for subsequent evaluations) based on documented time spent (40+ minutes for 99221, 55+ for 99222, 75+ for 99223, 25+ for 99231, 35+ for 99232, 50+ for 99233). Providers must document total face-to-face and virtual/telephone time on the encounter date to support code selection. Update claim submission workflows and provider education materials to highlight dual coding requirements (medical + behavioral health diagnoses). This is an encouragement/guidance policy, not a mandate; however, claims submitted without appropriate behavioral health coding when applicable may not reflect the full clinical picture and could impact reimbursement accuracy.