All PlansDocumentationMedium impact
Consider Behavioral Health Evaluations During Hospital Stays
BCBS Oklahoma·OK · Psychiatry, Internal Medicine, Critical Care·General
Effective date
Aug 19, 2026
We identified it
Aug 20, 2026
Summary
This new policy encourages hospitals to conduct behavioral health evaluations for medically hospitalized members who exhibit behavioral health symptoms, with coordinated follow-up care within 30 days of discharge. Billing teams must now ensure claims for psychiatric consultations during medical inpatient stays include both the behavioral health diagnosis and the appropriate CPT E/M codes (99221-99223 for initial visits, 99231-99233 for subsequent visits) based on documented time and complexity.
Action Required
Effective immediately (August 19, 2026): Billing team must update claim submission procedures to require documentation of both the behavioral health diagnosis and the appropriate psychiatric E/M CPT code when members receive psychiatric consultations during medical inpatient admissions. Providers must document total time spent (face-to-face and virtual/telephone) on the date of encounter to support code selection: 99221 (≥40 min), 99222 (≥55 min), 99223 (≥75 min) for initial consultations, or 99231 (≥25 min), 99232 (≥35 min), 99233 (≥50 min) for subsequent consultations. Train clinical staff and providers to ensure behavioral health follow-up is arranged within 30 days post-discharge (inpatient admission, partial hospitalization, intensive outpatient, or outpatient appointment). Update encounter templates and billing system validation rules to flag missing behavioral health diagnoses on inpatient psychiatric consultation claims. Monitor claims for compliance with time-based thresholds; claims lacking sufficient documentation of encounter time or missing secondary behavioral health diagnosis may face denials or delays.