Medicare AdvantageDocumentationMedium impact
Consider Behavioral Health Evaluations During Hospital Stays
BCBS Illinois·IL · Psychiatry, Internal Medicine·General
Effective date
Aug 19, 2026
We identified it
Aug 20, 2026
Summary
This new Blue Cross Blue Shield policy encourages behavioral health evaluations for hospitalized members with coexisting physical and behavioral health conditions. Billing teams must now ensure claims for psychiatric consultations during medical inpatient stays include both the secondary behavioral health diagnosis and appropriate psychiatric E/M CPT codes (99221–99223 for initial visits, 99231–99233 for subsequent visits), with time-based code selection per AMA guidelines.
Action Required
By September 19, 2026: Billing team and providers must implement the following: (1) Update claim submission procedures to require inclusion of the behavioral health diagnosis code when a psychiatric consultation is provided during a medical inpatient admission; (2) Ensure providers document total time (face-to-face and virtual combined) spent on behavioral health evaluations to support correct CPT code selection (99221/99231 minimum 40/25 min, 99222/99232 minimum 55/35 min, 99223/99233 minimum 75/50 min); (3) Train billing staff and providers on proper time-based code assignment per AMA E/M guidelines referenced in the policy; (4) Review and update encounter forms/templates in the EMR to prompt providers to document behavioral health diagnoses and total encounter time when psychiatric consultations occur during medical admissions. Failure to include behavioral health diagnosis codes and correct psychiatric E/M codes may result in claim denials or underpayment.