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Behavioral Health Tip Sheets

July 21, 2020

We’ve created two new behavioral health tip sheets to help you provide quality care to our members. The following tip sheets include documentation recommendations, best practices and billing codes:

Initiation and Engagement of Substance Abuse or Dependence Treatment

  • Members ages 13 and older
  • New1 diagnosis of alcohol or other drug (AOD) abuse or dependence
  • Treatment may occur in the inpatient, residential, outpatient,2 medication-assisted treatment (MAT) or telehealth setting

Follow Up After Hospitalization for Mental Illness

  • Members ages 6 and older
  • Discharged from an acute inpatient hospital stay
  • Principal diagnosis at discharge is mental illness or intentional self-harm
  • Outpatient follow-up visits must be with a mental health provider3 (includes telehealth visits) or in certain outpatient4 settings

1 Defined as no diagnosis of AOD abuse or dependence in previous 60 days

2 Outpatient treatment includes an intensive outpatient or partial hospital program

3 Psychologist, Psychiatrist, Clinical Social Worker, Mental Health Occupational Therapist, Psychiatric/Mental Health Nurse

Practitioner/Clinical Nurse Specialist, Neuropsychologist, Psychoanalyst, Professional Counselor, Marriage and Family Therapist

4 Community mental health center, electroconvulsive therapy, transitional care management services and includes intensive outpatient or partial hospital programs

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.