Medicare AdvantageDocumentationMedium impact
Consider Behavioral Health Evaluations During Hospital Stays
BCBS Montana·MT · Psychiatry, Internal Medicine, Critical Care·General
Effective date
Aug 19, 2026
We identified it
Aug 20, 2026
Summary
Blue Cross is encouraging behavioral health evaluations for hospitalized members with coexisting mental health conditions to reduce readmissions. Billing teams must ensure claims for psychiatric consultations during medical inpatient stays include both the behavioral health diagnosis and appropriate CPT E/M codes (99221-99223 for initial, 99231-99233 for subsequent visits) based on time spent and complexity.
Action Required
Effective immediately: Providers and billing team must ensure that when a member receives a psychiatric consultation during medical inpatient admission with a secondary behavioral health diagnosis, claims include: (1) the behavioral health diagnosis code(s), and (2) the correct CPT code (99221-99223 for initial evaluation or 99231-99233 for subsequent visits) selected based on total time spent by the psychiatrist or qualified mental health professional on the date of encounter. Billing team should update claim submission guidelines and provider education materials to reflect time-based CPT code selection per AMA guidelines. Verify documentation in medical records supports the time threshold for the selected CPT code. Failure to include both the behavioral health diagnosis and appropriate CPT code may result in claim denials or underpayment.