Non-medical behavioral health practitioners can now be reimbursed for prolonged psychotherapy services

For dates of services on or after Feb. 1, 2020, non-medical behavioral health practitioners are eligible for reimbursement of services associated with procedure codes *99354 and *99355.

These apply to evaluation and management-related psychotherapy services in the office or other outpatient setting when they require direct patient contact beyond the usual time:

• Use *99354 to bill the first hour of a prolonged service.
• Use *99355 to bill each additional half hour of a prolonged service. 

Here’s additional information you need to know:

• These codes must be billed on the same day and by the same practitioner as the companion evaluation and management or psychotherapy codes.
• You can bill these codes for BCN commercial, BCN Advantage^SM or Medicare Plus Blue^SM members only. You can’t bill them for Blue Cross’ commercial members at this time; watch for updates.
• For BCN commercial members, standard referral requirements currently apply. However, we’re reconfiguring our systems so that, in the near future, no referral will be required. Watch for more information on this in an upcoming web-DENIS message and in articles in future issues of our provider newsletters.
• These services don’t require authorization for any member.
• The following licensed providers can bill these codes for services related to behavioral health:
• Board-eligible or board-certified psychiatrists
• Psychologists who have a doctoral or master’s degree and a full or limited license
• Master’s-level social workers and professional counselors who have a master’s degree and a full license
• Marriage and family therapists who have a master’s degree and a full license
• Clinical nurse specialists and nurse practitioners who are certified and licensed 
• Physician assistants who have a master’s degree and are licensed
• You must comply with the American Medical Association’s billing guidelines.
• The medical record must clearly show the medical necessity for using these codes. 
• You should document your intervention and revise the member’s treatment plan, as needed, if the member needs these interventions frequently. You can also request consultation if the member isn’t making progress.
• We’re reviewing our medical policies to include these codes for a broader range of services than currently reflected.