This article is for the mental health and primary care providers who care for our members
Starting March 31, 2024, Blue Cross will cover an annual mental health wellness exam as required by the Addressing Barriers to Care Act (ABC Act) to improve mental health care across Massachusetts. This exam may be conducted as part of the annual preventive visit with a primary care provider (PCP), or as a standalone visit with a primary care provider or licensed mental health professional.
Because the mental health wellness exam is considered preventive care, there is no out-of-pocket cost for members in most plans.
What is the mental health wellness exam?
The exam includes taking the patient’s mental health history, appropriate screening tests, shared decision-making (that could include lifestyle education and counseling) and a discussion about next steps such as referrals for treatments and medication options. The mental health wellness exam may or may not result in a diagnosis.
Who may administer the exam
- A Massachusetts licensed mental health professional
- A Massachusetts primary care provider, including OB/GYNs, as a separate exam or as part of the annual wellness visit.
How to bill for the exam
We will reimburse claims submitted with dates of service on or after March 31, 2024 that contain the following procedure and diagnosis codes. To ensure that members are not subject to out-of-pocket cost, bill with modifier 33 in the first modifier field on your claim to indicate that the evaluation is for preventive purposes.
|
Code |
Definitions and guidance |
|---|---|
|
Procedure code 90791 |
An integrated biopsychosocial assessment, including history, mental status, and recommendations |
|
Diagnosis code: Z13.30 |
Encounter for screening examination for mental health and behavioral disorders, unspecified |
Resources
For more details, please refer to:
- Our Mental Health and Substance Use payment policy. To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or go to Office Resources>Policies & Guidelines>Payment Policies.
- The Division of Insurance Bulletin 24-02, Appendix A for mental health wellness examination criteria and guidelines based on input from medical providers convened by the Massachusetts Department of Mental Health.
For more details, please refer to our Mental Health payment policies for billing guidelines below:
- Mental Health and Substance Use
- Telehealth (Telemedicine) - Mental Health
- The Division of Insurance Bulletin 24-02, Appendix A, for mental health wellness examination criteria and guidelines based on input from medical providers convened by the Massachusetts Department of Mental Health.
Questions?
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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