Montana Senate Bill 217 Psychiatric Collaborative Care And Primary Care Behavioral Health Mandate

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.