Nov. 02, 2021
Montana Senate Bill 217 expands coverage of certain outpatient psychiatric services delivered through the psychiatric collaborative care and primary care behavioral health models.
Applies to:
- Retail
- Fully-Insured Group
- State of Montana Employee Plan, Montana University System Employee Plan, and other state and local governmental plans
- Self-funded Multiple Employer Welfare Arrangements
Effective date: The law applies to policies issued, amended, delivered, or renewed on or after Jan. 1, 2022.
What’s changing: The mandate expands outpatient benefits to include care that’s delivered in two ways:
- Primary care behavioral health: services provided in a primary or specialty care setting that recognizes licensed psychologists as either consultants or direct service providers
- Psychiatric collaborative care: services provided by a primary care provider and a care manager in collaboration with a psychiatric consultant
The mandate specifies certain billing codes that must be covered to meet this requirement.
What’s the impact to our plans: We are updating our coding to allow claims for psychiatric services that meet the expanded definition, including:
- Care management services for behavioral health conditions
- Health behavior assessment and intervention
- Telephone/internet/electronic health record consultations
What are the impacted codes?
Care management services for behavioral health conditions
- 99492
- 99493
- 99494
- 99484
Health behavior assessment and intervention
- 96156
- 96158
- 96159
- 96164
- 96165
- 96167
- 96168
- 96170
- 96171
Interprofessional telephone/internet/electronic health record consultations
- 99446
- 99447
- 99448
- 99449
- 99451
For more information, contact your network representative.