Highmark BlueShield Billing Highlights
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1 SEPARATELY BILLED OUTPATIENT SERVICES LOCATOR 4: Type of Bill 1st digit always = 1 2nd digit always = 3 3rd digit = 1 LOCATOR 6: Statement Covers Period - required The From and Through dates that correspond to the dates of service. LOCATOR 42: Revenue Codes required 0900 Psychiatric/Psychological Treatments Electroshock Treatment 0902 Milieu Therapy 0903 Play Therapy 0904 Activity Therapy 0909 Psychiatric/Psychological Treatments/Other 0910 Psychiatric/Psychological Services Psychiatric/Psychological Services/Rehabilitation Psychiatric/Psychological/Intensive Psychiatric/Psychological/Less Intensive Psychiatric/Psychological/Individual Therapy Psychiatric/Psychological/Group Therapy Psychiatric/Psychological/Family Therapy Psychiatric/Psychological/Bio Feedback Psychiatric/Psychological/Testing Psychiatric/Psychological/Other 0949 Other Therapeutic Services
2 LOCATOR 44: HCPCS/Rate/HIPPS Code Required Psychiatric Diagnostic Interview Examination Interactive Psychiatric Diagnostic Interview Examination Individual Psychotherapy minutes Individual Psychotherapy minutes with E&M Individual Psychotherapy minutes Individual Psychotherapy minutes with E&M Individual Psychotherapy minutes Individual Psychotherapy minutes with E&M Individual Psychotherapy, interactive, minutes Individual Psychotherapy, interactive, minutes w/e&m Individual Psychotherapy, interactive, minutes Individual Psychotherapy, interactive, minutes w/e&m Individual Psychotherapy, interactive, minutes Individual Psychotherapy, interactive, minutes w/e&m Individual Psychotherapy minutes Individual Psychotherapy minutes with E&M Individual Psychotherapy minutes Individual Psychotherapy minutes with E&M Individual Psychotherapy minutes Individual Psychotherapy minutes with E&M Individual Psychotherapy, interactive, minutes Individual Psychotherapy, interactive, minutes w/e&m Individual Psychotherapy, interactive, minutes Individual Psychotherapy, interactive, minutes w/e&m Individual Psychotherapy, interactive, minutes Individual Psychotherapy, interactive, minutes w/e&m Family Psychotherapy, without patient Family conjoint psychotherapy Multiple-family group psychotherapy Group psychotherapy Interactive group psychotherapy Pharmacological management Narcosynthesis for psychiatric diagnostic and therapeutic purposes ECT: single seizure, w/monitoring ECT: multiple seizures, per day Individual psycho physiological therapy, minutes Individual psycho physiological therapy, minutes Hypnotherapy Psychological testing, per hour Assessment of aphasia, with interpretation and report, per hour Developmental testing, limited w interpretation and report
3 LOCATOR 44: HCPCS/Rate/HIPPS Code Required (Cont d) Developmental testing, extended w interpretation and report, per hour Neurobehavioral status exam w interpretation and report, per hour Neuropsychological testing battery w interpretation & report, per hour Office Consultation: Focused: straightforward Office Consultation: Expanded: straightforward Office Consultation: Detailed: low complexity Office Consultation: Comprehensive: moderate complexity Office Consultation: Comprehensive: high complexity Emergency Room Visit Emergency Room Visit Emergency Room Visit Emergency Room Visit Emergency Room Visit One of the following Professional Credential Modifier Codes is required: AM Psychiatrist AH Psychologist AJ Master s Degree Prepared Therapist, Social Worker or Counselor GF Pyschiatric CRNP LOCATOR 46: Service Units - required Each date of service must be billed as a separate line item. LOCATOR 50: Payer Name required For paper UB claim submission enter Highmark 378. LOCATOR 56: National Provider Identifier Required for providers on or after the mandated HIPAA National Provider Identifier Implementation date.
4 LOCATOR 67: Principal Diagnosis Code and Present on Admission In order for a claim to be classified as Substance Abuse or Mental Health one of the following ICD-9-CM diagnosis codes is required: Mental Health Mental Health Mental Health Substance Abuse Mental Health Mental Health The POA is not required at this time. LOCATOR 76: Attending Physician required Until the mandated HIPAA date for the National Provider Identifier (NPI), Highmark will accept either NPI or UPIN. On paper submitted claims report the appropriate qualifier identifying the number being reported: 1G = Provider UPIN number G2 = Provider commercial number OB = State License Number LOCATOR 81: Code-Code Field-Situational This field may be used to report additional codes related to a form locator. NOTE: Taxonomy number is not required, but encouraged for proper enumeration and payment of claims. Use qualifier B3 when reporting taxonomy.
5 NOTE: Always bill substance abuse treatment services and detoxification services on separate claims. If more than one classification appears on the claim, the processing system will be unable to assign the single classification code it needs in order to pay the claim correctly. Reference Facility Bulletin PSYCH C or ADR C for billing guidelines. REMINDER: serve only as a tip sheet for some Locator information needed on UB claim submission. Reference the Highmark Facility Billing Reference Manual for Highmark s complete locator requirements. The official UB-04 Data Specifications Manual is available through the National Uniform Billing Committee (NUBC.org).
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AUTHORIZATION RQUIREMENTS Notes (0= No Additional Comments) 101 All inclusive room and board On 0
100 All inclusive room and board 0 101 All inclusive room and board 0 114 Room and Board- private psychiatric 0 116 Room and Board- private room detoxification 0 118 Room and Board- private rehabilitation
Page 1 of 11. Effective 9/15/2018 AUTHORIZATION REQUIREMENT LEVEL OF CARE. Notes (0 = No Additional Comments)
100 All inclusive room and board On 0 101 All inclusive room and board On 0 104 Anesthesia, ECT On 0 114 Room and Board- private psychiatric On 0 116 Room and Board- private room detoxification On 0 118
CMHC AUTHORIZATION REQUIREMENT. Non-CMHC Notes (0 = No SERVICE DESCRIPTION
Non- Notes (0 = No Non- Notes (0 = No 100 All inclusive room and board On 0 On 0 101 All inclusive room and board On 0 On 0 104 Anesthesia, ECT On 0 On 0 114 Room and Board- private psychiatric On 0 On
Revenue/Procedure Code Service Group Matrix
0 114 Room and Board- private psychiatric 0 118 Room and Board- private rehabilitation 0 124 Room and Board -semi private psychiatric 0 128 Room and Board - semi private rehabilitation 0 134 Room and Board
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DESCRIPTION REQUIREMENT RESPONSIBILITY AUTH PARAMETERS 90785 Interactive complexity add-on code MD,NP Psychiatric diagnostic evaluation (no medical 90791 Services) 90792 Psychiatric diagnostic evaluation
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Behavioral Health Authorization Requirements*
100 All inclusive room and board MN 0 MN 0 101 All inclusive room and board MN Use MN Criteria for IP Medically-Supervised detox MN 0 104 Anesthesia, ECT MN 0 MN 0 114 Room and Board- private psychiatric
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