All PlansDocumentationMedium impact
Consider Behavioral Health Evaluations During Hospital Stays
BCBS Texas·TX · Psychiatry, Internal Medicine, General Practice +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. Billing teams must ensure claims for psychiatric consultations during medical inpatient stays include the secondary behavioral health diagnosis and appropriate CPT evaluation/management codes (99221-99223 for initial visits, 99231-99233 for subsequent visits).
Action Required
By September 19, 2026: Billing team must update claim submission procedures to require providers to include both the secondary behavioral health diagnosis AND the appropriate psychiatric E/M CPT code (99221-99223 for initial hospital inpatient evaluations or 99231-99233 for subsequent evaluations) when a member receives a psychiatric consultation during medical inpatient admission. Update provider education materials and encounter forms to clarify time-based code selection (40 min minimum for 99221, 55 min for 99222, 75 min for 99223; 25 min for 99231, 35 min for 99232, 50 min for 99233). Implement system edits to flag claims missing behavioral health diagnoses or incorrect CPT codes for psychiatric inpatient consultations. Educate billing staff that claims without proper diagnosis and code pairing may be denied or delayed.