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BCBS IllinoisMedicare Advantage · Documentation · General · IL · Psychiatry, Internal MedicineMedium impact

Consider Behavioral Health Evaluations During Hospital Stays

Act
by Sep 19, 2026
Effective date
Aug 19, 2026
Identified
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.

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What to do

by Sep 19, 2026 · 5 steps
01Billing team and providers must implement the following.
02Update claim submission procedures to require inclusion of the behavioral health diagnosis code when a psychiatric consultation is provided during a medical inpatient admission.
03Ensure 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).
04Train billing staff and providers on proper time-based code assignment per AMA E/M guidelines referenced in the policy.
05Review 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.
If missed: Failure to include behavioral health diagnosis codes and correct psychiatric E/M codes may result in claim denials or underpayment.

Codes mentioned

992219922299223992319923299233

Original notice

Consider Behavioral Health Evaluations During Hospital Stays
bcbsil.com · Always check the source before changing claims.
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Related policy hubs

BCBS Illinois policiesIL policy changesPsychiatryInternal MedicineCode 99221Code 99222Code 99223Code 99231Code 99232Code 99233

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