Currentblue cross blue shield - michiganPolicy N/A

Urgent care and crisis services (PDF)

Defines program and clinical requirements, staffing, services, documentation/reporting, and reimbursement expectations for psychiatric urgent care centers, mobile crisis programs, and crisis stabilization units for Blue Cross Blue Shield of Michigan commercial, Medicare Plus Blue, Blue Care Network commercial and BCN Advantage members.

Policy Summary

Payerblue cross blue shield - michigan

PolicyUrgent care and crisis services (PDF)

Policy CodePolicy N/A

Change TypeRevised (Nov 2025)

Effective Date

Next Review Date

Key ActionProvide required documentation and operational compliance (including annual reports and timely treatment plans) per program requirements.

SourceLink

POLICY UPDATE CHANGES

Document revised November 2025 to show specifications for psychiatric urgent care centers, mobile crisis programming and crisis stabilization units.

3Program types specified

48Treatment plan threshold (hrs)

30Max mobile crisis follow-up (days)

Coverage Summary

This policy specifies behavioral health urgent care and crisis services across Blue Cross Blue Shield of Michigan product lines, covering psychiatric urgent care centers, mobile crisis programs, and crisis stabilization units for Blue Cross commercial, Medicare Plus Blue, Blue Care Network commercial and BCN Advantage members. It applies to members with mental health disorders, substance use disorders, or both and defines appropriate settings, staffing, services, documentation/reporting, and reimbursement expectations.

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Psychiatric urgent care centers provide immediate assessment and short-term stabilization as a lower-acuity alternative to emergency departments for members with acute psychiatric symptoms who are medically stable and voluntarily consenting; services are delivered by a multidisciplinary team (including master's-level clinicians and certified peer support specialists) and may be offered in-person or via telehealth for short-term crisis intervention and care planning.

Mobile crisis programs provide emergency mobile psychiatric and behavioral health intervention in community settings for children and adults, require affiliation with additional crisis services and accreditation as an outpatient psychiatric facility, are staffed by licensed master's-level clinicians supported by certified peer specialists with a medical director on call, must complete an individualized treatment plan within 48 hours of the initial intervention, and may provide services for up to 30 days after the initial intervention.

The policy’s operational expectations include facility accreditation and permitting health plan review of credentials and outcomes, required annual reporting of cases/services/dispositions/follow-up (and lengths of stay for crisis stabilization), initiation of involuntary processes when imminent danger is present, and financial/authorization rules such as no prior authorization for psychiatric urgent care centers and application of outpatient copay/coinsurance. Coverage stance: mixed. Key stats: 3 program types specified; treatment plan completion threshold 48 hours; mobile crisis follow-up window 30 days.

Psychiatric Urgent Care Center — Medical Necessity Criteria

Psychiatric Urgent Care Center Coverage Criteria

Covered outpatient urgent behavioral health services when ALL of the following are met:

ALL of the following

Member is experiencing acute psychiatric symptoms and cannot wait for routine outpatient care but is not necessarily experiencing a medical emergency
Member is medically stable and not under the influence of substances
Medical stability required
Member consents to and is willing to participate in a voluntary evaluation
Voluntary evaluations only
Services are provided by a multidisciplinary team that includes master's-level clinicians and certified peer support specialists; external consultant (e.g., psychiatrist) as needed
Services provided face-to-face in office or via virtual sessions (telehealth permitted)
Allowed services (ANY of)
- Immediate assessment and evaluation
- Crisis intervention
- Development of a plan of care for immediate and short-term interventions shared with the member
- Referrals to appropriate resources including inpatient, outpatient or other services
- Medication consultation and medication management as needed (may include initiation or adjustments but not ongoing long-term management)
Not provided (must NOT provide any of)
- Ongoing long-term mental health treatment
- In-depth diagnostic evaluations for specific conditions (e.g., autism spectrum disorder)
- Medical assessments or physical exams or management of medical emergencies
- Court-mandated or forensic evaluations
- Return-to-work or school clearances

ALL of the following

Length of stay is short-term focused on stabilization and referral
No prior authorization required for psychiatric urgent care center services
Outpatient office copayment and coinsurance apply to services provided in psychiatric urgent care centers

Prior Authorization

Prior authorization not required for psychiatric urgent care

No prior authorization is required for psychiatric urgent care center services. Outpatient office copayment and coinsurance apply to services provided in psychiatric urgent care centers.

Billing Rule

Member cost sharing applies

Outpatient office copayment and coinsurance apply to services in psychiatric urgent care centers.

Mobile Crisis Program — Medical Necessity & Operational Criteria

Mobile Crisis Program Coverage Criteria

Mobile crisis services covered when ALL of the following are met:

ALL of the following

Program offers emergency mobile psychiatric and behavioral health intervention for children and adults
Program has written affiliation/link to additional crisis services (e.g., crisis stabilization, crisis residential) and coordinates referrals with complete transmittal of assessment and progress information
Program is provided by an accredited outpatient psychiatric care facility meeting Blue Cross/BCN general outpatient psychiatric facility requirements
Staffing includes qualified/licensed master's-level mental health and substance use disorder professionals supported by certified peer support specialists and a medical director available on call
Services provided (ANY of)
- Initial evaluation and assessment
- Preliminary treatment plan at initial meeting
- Short-term individual and family therapy
- Care management addressing social determinants of health and coordination with other providers
- Face-to-face crisis intervention in the community (in-person or audiovisual) — telephone-only is not sufficient
Individualized treatment plan must be completed within 48 hours of the initial crisis intervention (may be included in warm handoff to next level of care)
Services may be provided up to 30 days after the initial intervention (including additional crisis intervention)
Program must initiate involuntary processes if imminent danger not already addressed (coordinate with authorities/EMS/911 as appropriate)
Program must track progress and dispositions and provide an annual report to the health plan including number of cases, services used, dispositions, follow-up and aftercare results

Documentation Required

Face-to-face requirement for initial mobile crisis intervention

Initial mobile crisis intervention must be face-to-face in the community and can be provided in person or via audiovisual means; telephone-only interventions are not sufficient.

Documentation Required

Treatment plan timing

Individualized treatment plan must be completed within 48 hours of the initial crisis intervention.

48 hours

Documentation Required

Accreditation and facility requirements

Mobile crisis programs must be provided by an accredited outpatient psychiatric care facility that meets Blue Cross/BCN general outpatient psychiatric facility requirements and must allow the health plan behavioral health medical director and leadership to review the provider's credentials, outcomes, programming and quality.

Crisis Stabilization Program — Medical Necessity & Operational Criteria

Crisis Stabilization Program Coverage Criteria

Crisis stabilization unit coverage when ALL of the following are met:

ALL of the following

Program is a 24/7 crisis program offering emergency behavioral health intervention for children and adults
Program is provided by an accredited outpatient psychiatric care facility meeting Blue Cross/BCN general outpatient psychiatric facility requirements
Services performed by a multidisciplinary team (including psychiatrist, nurses, master's-level clinicians, certified peer support specialists)
Team includes psychiatrist, nurses, master's-level clinicians, certified peer support
Program components (ANY of)
- Room and board support
- Psychiatric assessment and treatment
- Systematic use of evidence-based screening tools (PHQ-9, GAD-7, Y-BOCS, BRS, PANSS)
- Suicide risk assessment using evidence-based tools (e.g., C-SSRS Screen)
- Routine use of acuity scoring tools (LOCUS, CAFAS, ASAM criteria)
- Medication initiation, management and education (specialty pharmacy medications may be separately reimbursed)
- Biopsychosocial assessment
- Psychotherapy initiation
- Nursing assessment, psychoeducation, medication reconciliation/instruction
- Certified peer support services
- Individualized treatment plan
- Medical assessment
- Discharge planning and coordination of care with outside providers
Disposition and treatment plan targeted to be developed within 24 hours but not after 48 hours
Program must initiate involuntary processes if imminent danger not already addressed (coordinate with authorities/EMS/911 as appropriate)
Facility must have appropriate security measures to track individuals who leave against medical advice and notify authorities when harm is indicated
Program must allow health plan behavioral health medical director and leadership to review credentials, outcomes, programming and quality and should be certified by local governing entity if certification available
Program will conduct and track progress and dispositions and provide annual report including number of cases, services used, lengths of stay, dispositions, follow-up and aftercare results

Documentation Required

Treatment plan timing

Disposition and treatment plan for crisis stabilization are targeted to be developed within 24 hours but must not be later than 48 hours.

24 hours
48 hours

Denial Risk

Involuntary processes initiation

Providers must initiate involuntary processes and coordinate with appropriate authorities (for example, 911/EMS or law enforcement) when imminent danger involving the member has not already been addressed; failure to initiate or coordinate these processes when indicated may pose clinical risk and compliance issues with the health plan.

Documentation Required

Annual reporting requirement

Mobile crisis and crisis stabilization programs must provide an annual report to the health plan that includes the number of cases, services used, dispositions, follow-up and aftercare results; crisis stabilization reports must also include lengths of stay.

Definitions

Psychiatric urgent care center: A lower-acuity alternative to emergency departments offering immediate assessment and short-term stabilization for acute psychiatric symptoms; not for medical emergencies or ongoing long-term treatment. Services are provided by a multidisciplinary team and may be delivered in-person or via virtual sessions.

Mobile crisis program: Emergency mobile psychiatric and behavioral health intervention delivered in community settings for children and adults, with written linkage to additional crisis services, provided by an accredited outpatient psychiatric facility, staffed by licensed master's-level clinicians and certified peer support specialists, and requiring a face-to-face initial crisis intervention (in-person or audiovisual) and an individualized treatment plan completed within 48 hours.

Crisis stabilization program: A 24/7 crisis program offering emergency behavioral health intervention to stabilize symptoms and facilitate transition to less restrictive care; provided by an accredited outpatient psychiatric facility with a multidisciplinary team (including psychiatrist and nurses) and using evidence-based screening and acuity tools, with disposition and treatment plans targeted within 24 hours and not after 48 hours.

Background

Purpose: to specify settings, staffing, services, documentation/reporting and payment/operational expectations for psychiatric urgent care centers, mobile crisis programs and crisis stabilization units across BCBSM commercial, Medicare Plus Blue, BCN commercial and BCN Advantage product lines.

Levels of care differentiation: psychiatric urgent care centers provide lower-acuity immediate assessment and short-term referral; mobile crisis programs deliver community-based face-to-face crisis intervention with short-term follow-up and linkage to higher levels of care; crisis stabilization units offer 24/7 multidisciplinary stabilization with more intensive assessment, medication management and transition planning.

Services not provided/limitations: psychiatric urgent care centers do not provide medical assessments for emergencies, in-depth diagnostic evaluations for specific conditions, long-term ongoing treatment, court-mandated/forensic evaluations, or return-to-work/school clearances. Mobile crisis initial services must be face-to-face (telephone-only is insufficient).

Operational and payment expectations: psychiatric urgent care requires no prior authorization and outpatient copayment/coinsurance apply; mobile crisis and crisis stabilization programs must be provided by accredited outpatient psychiatric facilities, allow plan review of credentials/outcomes/programming, initiate involuntary processes when imminent danger is present, complete individualized treatment plans within specified thresholds (mobile crisis 48 hours; crisis stabilization targeted within 24 hours and not after 48 hours), and submit annual reports including cases, services, dispositions and follow-up (crisis stabilization also reports lengths of stay).

Policy Summary

Payerblue cross blue shield - michigan

PolicyUrgent care and crisis services (PDF)

Policy CodePolicy N/A

Change TypeRevised (Nov 2025)

Effective Date

Next Review Date

Key ActionProvide required documentation and operational compliance (including annual reports and timely treatment plans) per program requirements.

SourceLink

On This Page

OpenPayer

Urgent care and crisis services (PDF)

Coverage Summary

Psychiatric Urgent Care Center — Medical Necessity Criteria

Mobile Crisis Program — Medical Necessity & Operational Criteria

Crisis Stabilization Program — Medical Necessity & Operational Criteria

Definitions

Coding

Provider Actions & Billing Impact

Background

Revision History