BlueCross and BlueShield of Montana Medical Policy/Codes
Mental Health Services
Chapter: Mental Health
Current Effective Date: November 26, 2013
Original Effective Date: November 26, 2013
Publish Date: August 26, 2013
Description

Mental Health services are treatment methods directed toward identifying specific behavior pat­terns, factors determining such behavior, and effective goal-orient­ed therapies.

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions.  Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coverage

Modalities used for the treatment of mental health conditions must be appropriate to the specific mental health disorder(s) of the patient being treated. The degree of impairment should be a factor in determining frequency and duration of therapeutic services.

The following treatment modalities may be considered medically necessary if they are determined to be medically appropriate to the specific mental health condition:

  • Individual psychotherapy
  • Group therapy
  • Family Counseling
  • Pharmacotherapy.

NOTE:

  • Benefits should be provided on a single provider basis when rendered by co-therapists.
  • Phone based therapy (mental health counseling or psychotherapy) may be a contract exclusion under mental health contracts.

The following services are considered not medically necessary:

  • Services directed toward enhancing one's personality;
  • Consciousness raising;
  • Vocational or religious coun­seling;
  • Group socialization;
  • Activities primarily of an educational nature;
  • Behavioral modification for lifestyle enhancement;
  • Primal therapy (psychotherapy in which the patient is encouraged to relive his/her early traumatic experiences);
  • Obesity control therapy;
  • Rolfing (structural integration): a system of soft tissue manipulation and movement education that theorizes there is a correlation between muscular tensions and pent up emotions;
  • Bioenergetic therapy;
  • Sleep therapy (narcosis):  a non-specific and reversible depression of function of the central nervous system marked by stupor or insensibility produced by drugs;
  • Carbon dioxide therapy: form of rarely used shock therapy employed for the treatment of withdrawn psychotic patients, in which unconsciousness is induced by the administration of carbon dioxide gas by inhalation);
  • Dance therapy;
  • Music therapy;
  • Services for psychotherapeutic services concurrently by more than one mental health provider;
  • Services credited toward earning a degree or furtherance of the educa­tion or training of the patient; and
  • Phone, E-mail or web-based psychotherapy (NOTE: Member’s contract benefits and plan legislation may apply).  

Rationale

2013 Update

The therapies defined under this policy include:

  • Individual psychotherapy: a form of therapy involving the therapist and a single patient dependent principally on ver­bal interchange, including crisis inter­vention, and insight oriented be­havior modification.
  • Group therapy: a form of treatment in which carefully selected patients are placed into a distinct group (minimum of four, maximum of 12), guided by a psychothera­pist for the purpose of help­ing one another effect per­sonality change.  By using a variety of technical maneu­vers and theoretical con­structs, the psychotherapist uses the members' interaction to bring about this change.
  • Family counseling (conjoint): involves two or more family members and is not intended to be treatment for the relatives but to promote understanding of the patient and more acceptable ways of family functioning.
  • Pharmacotherapy: involves the prescription of medications, observation or response and regulation of dosage.

A search of peer reviewed literature through September 2013 identified no new clinical trial publications or any additional information that would change the coverage position of this medical policy.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

ICD-9 Codes
94.01 to 94.69, 290.0 to 319
Procedural Codes: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90863, 90845, 90846, 90847, 90849, 90853, 90865, 90882, 90885, 90887, 90899, 96150, 96151, 96152, 96153, 96154, 96155
References
  1. National Institute of Health Consensus Development Conference Statement, Electroconvulsive Therapy. June 10-12, 1985.
  2. Practice Guideline for the treatment of patients with bipolar disorder. Blue Cross Blue Shield Association Medical Policy Reference Manual Mental Health Introduction (1995 December 1) 3.01.
  3. American Psychiatric Association (1994)151 (12 Supplement):1-36.
  4. Practice Parameters for the Assessment and Treatment of Children and Adolescents with Depressive Disorders. AACAP Journal of the American Academy of Child and Adolescent Psychiatry (1998 October) 37(10 Supplement):63S-83S.
  5. Manhal-Baugus, M.  E-therapy: practical, ethical, and legal issues. Cyberpsychology and Behavior (October 2001) 4(5): 551-63. 
  6. Miller, L., M. Weissman. Interpersonal psychotherapy delivered over the telephone to recurrent depressives. A pilot study. Depression and Anxiety. (2002) 16(3):114-7.
  7. Lynch, T.B., Morse, J.Q., et al. Dialectical behavior therapy for depressed older adults: a randomized pilot study. American Journal of Psychiatry (January-February 2003)  11(1):33-45.
  8. Castelnuovo, G., Gaggioli, A., et al. From psychotherapy to e-therapy: the integration of traditional techniques and new communication tools in clinical settings. Cyberpsychology and Behavior (August 2003) 6(4): 375-82.
History
August 2013  New 2013 BCBSMT medical policy.
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Mental Health Services