Currentblue cross blue shield - michiganPolicy N/A

Mobile crisis and crisis stabilization (behavioral health)

Defines coverage, payment, billing, and provider requirements for mobile crisis intervention and onsite crisis stabilization services as an enhanced benefit under BCN Advantage Medicare Advantage plans that include this benefit.

Policy Summary

Payerblue cross blue shield - michigan

PolicyMobile crisis and crisis stabilization (behavioral health)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionBill services on CMS 1500/UB-04/837 using BCN Advantage billing requirements and submit claims to BCN Advantage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2026policy effective date

outpatient, homepayable locations

≤2/wkS9485 limit

1 unit/15minH2011 limit

Coverage and Medical Necessity Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Members enrolled in BCN Advantage individual and select group plans that include this enhanced benefit; available in approved regions/counties.

Eligible providers: BCN Advantage contracted outpatient psychiatric centers; mobile crisis staffed by a master's level provider and peer counselor (face-to-face or via telemedicine).

Payable locations: outpatient psychiatric center, member's home or other location; excludes urgent care, emergency department, and inpatient hospital.

Diagnosis restrictions: ICD-10-CM F01-F99 (mental, behavioral and neurodevelopmental disorders).

Frequency and service limits: S9485 (crisis stabilization) — 1 unit per 24 hours, up to 2 units per rolling week; H2011 (mobile crisis) — 1 unit per 15 minutes, no unit limit per 24 hours, up to 30 rolling days.

Reimbursement: Provider paid the lesser of BCN allowed amount (see BCN Fee Schedules on Availity) or provider charge, minus member cost share; payment constitutes payment in full and balance billing to the member is prohibited.

Member cost sharing and collection: Outpatient office copay may apply; providers should collect applicable BCN Advantage cost sharing at time of service when possible; providers may not require an Advance Beneficiary Notice of Noncoverage (ABN) and must obtain a coverage determination if coverage is uncertain; members must be held harmless if a noncovered item is provided without prior coverage determination except for any applicable cost share.

Billing requirements: Bill on CMS 1500, UB-04 or 837 electronic equivalent; report CPT/HCPCS and diagnosis codes to highest specificity; include provider NPI; follow BCN Advantage unique billing requirements and submit claims to BCN Advantage.

HCPCS/CPT, Diagnosis Codes, and Limits

HCPCS Codes - CoveredHCPCSCovered

S9485	Crisis stabilization — one unit per 24 hours, up to two units per rolling week
H2011	Mobile crisis — one unit per 15 minutes, no unit limit per 24 hours, up to 30 rolling days

ICD-10 Diagnosis Restrictions - CoveredICD-10Covered

F01-F99

Mental, behavioral and neurodevelopmental disorders (ICD-10-CM range F01–F99)

Frequency limits — S9485 and H2011

S9485 (crisis stabilization)One unit per 24 hours; maximum two units per rolling week.

H2011 (mobile crisis)One unit per 15 minutes; no unit limit per 24 hours; authorized up to 30 rolling days.

Timeframe basisS9485 limits measured on a rolling weekly basis; H2011 authorized over a rolling 30-day period.

Billing, Submission, Eligibility, and Provider Requirements

Note

Eligibility and geographic availability

Members eligible for this BCN Advantage enhanced benefit include BCN Advantage individual members and select BCN Advantage group plan members that have elected the mobile crisis and crisis stabilization benefit. Coverage is available only for members located in approved regions/counties within Michigan as determined by BCN Advantage. Providers must verify member eligibility and plan election prior to scheduling or delivering services. Coverage mirrors or expands upon Original Medicare only where BCN Advantage has specifically added this enhanced benefit; if Original Medicare does not cover a service, BCN Advantage benefit terms (scope, reimbursement, member cost sharing) apply.

Applicable plans: BCN Advantage individual and select BCN Advantage group plans that include the enhanced mobile crisis/crisis stabilization benefit
Geographic availability: Benefit available only in approved regions/counties (Michigan) — verify county-level availability with BCN Advantage prior to service
Eligibility check: Confirm member is enrolled in a BCN Advantage plan that elected this enhanced benefit and confirm effective date of coverage

Billing Rule

Billing and submission instructions

Bill mobile crisis and crisis stabilization services on CMS-1500 (02/12), UB-04 or ANSI ASC X12 837 electronic claims. Use BCN Advantage billing requirements and report CPT/HCPCS and ICD-10-CM diagnosis codes to the highest level of specificity. Include your National Provider Identifier (NPI) on all claims. Electronic billing is preferred; Michigan providers can access ANSI 837/835 companion documents at bcbsm.com/providers/help/edi/. Providers outside Michigan participating with other Blue plans should contact their local Blue plan for billing instructions. Paper claims should be mailed to the BCN Advantage Claims address below.

Billable claim forms: CMS-1500 (02/12), UB-04, or 837 electronic equivalent
Provider identifier: Report NPI on every claim
Code reporting: Report CPT/HCPCS and ICD-10-CM codes to highest specificity (diagnoses F01–F99 for mental/behavioral/neurodevelopmental disorders when applicable)
Frequency & code limits: S9485 — one unit per 24 hours, up to two units per rolling week; H2011 — one unit per 15 minutes, no unit limit per 24 hours, up to 30 rolling days
Payable locations: Outpatient psychiatric center, patient’s home or other location (exclude urgent care, ED, inpatient hospital)
Electronic billing resources: Michigan providers — ANSI ASC X12N 837/835 resources at bcbsm.com/providers/help/edi/
Paper claims address: BCN Advantage Claims, Blue Care Network, P.O. Box 68753, Grand Rapids, MI 49516-8753

Service Definitions

Mobile crisis intervention — definition

Service labelMobile crisis intervention — face-to-face or via telehealth rapid response for members experiencing escalating emotional symptoms or behaviors that impair baseline functioning.

PurposeProvide immediate assessment, mitigation of crisis, connection to needed psychiatric care, treatment planning, family support and referrals to appropriate levels of care.

SettingsDelivered in the member's home, place of business, community location, or via telemedicine.

Mobile crisis services (detailed)

Core servicesPsychological evaluation, crisis mitigation, development of a treatment plan, connection to psychiatry for medication if needed, family intervention/support, and referrals to appropriate mental health or substance use services.

Staffing modelTeam includes a master's level provider and a peer counselor for mobile crisis response.

Service modalitiesProvides face-to-face visits in the community (home, work, other locations) and telehealth encounters as appropriate.

Billing codes referencedMobile crisis billed under H2011 (one unit = 15 minutes); crisis stabilization billed under S9485 (one unit per 24 hours).

Crisis stabilization — definition

DefinitionCrisis stabilization — onsite services at crisis stabilization centers and all support, services and treatments necessary to provide stabilization for members in acute behavioral health crises.

PurposeStabilize members whose emotional symptoms or behaviors have compromised their ability to function at baseline within family, living, work or community settings.

Typical componentsMay include observation, therapeutic interventions, care coordination and referral or placement into an appropriate level of care.