CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Behavioral Health Outpatient Professional Services - Payment Policy

Governs credentialing, provider specialty restrictions for CPT codes, medical record documentation, and reimbursement/coding guidance for outpatient professional behavioral health services for Blue Cross & Blue Shield of Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Outpatient Professional Services - Payment Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date01|01|2022

Next Review DateN/A

Key ActionNotify BCBSRI Behavioral Health Utilization Management at 800-274-2958 for admissions or preauthorization when required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12+listed credentialed clinician types

90791,90792,90832-90840common behavioral health CPT codes referenced

TU allowedextended pediatric interview

May requireauthorization requirement

Multiplerelated policies

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.

Coverage Overview

Coverage overview

Coverage varies by group/contract; refer to the member's Evidence of Coverage or Subscriber Agreement for benefit specifics. This policy segment does not define medical necessity criteria.

ALL of the following

Benefits and cost-sharing (coverage, deductibles, copayments) vary between groups and contracts; refer to the member's Evidence of Coverage or Subscriber Agreement for applicable Behavioral Health Services benefits.
Providers should check member-specific documents or contact BCBSRI for eligibility and benefit details before billing.
This section: Medical criteria — Not applicable (no medical necessity criteria are specified in this policy segment).

Behavioral Health CPT Codes and Billing Rules

Behavioral health outpatient CPTsCPTCovered

90791	Psychiatric diagnostic evaluation
90792	Psychiatric diagnostic evaluation with medical services
90832	Psychotherapy, 30 minutes
90834	Psychotherapy, 45 minutes
90837	Psychotherapy, 60 minutes
90785	Interactive complexity add-on
90839	Psychotherapy for crisis, first 60 minutes
90840	Each additional 30 minutes of crisis psychotherapy
90846	Family psychotherapy without patient present
90847	Family psychotherapy with patient present

1–10 of 11

1/2

Extended pediatric diagnostic interview threshold — modifier TU for >75 minutes for members under 18

Modifier and codesFor members under 18, extended psychiatric diagnostic interview examinations longer than 75 minutes may be billed with modifier TU (examples: 90791TU, 90792TU)

Time thresholdExtended services defined as interviews that extend longer than 75 minutes for members under 18

Effective dateApplies to dates of service on or after January 1, 2013

ScopeApplies to pediatric (children/adolescents) psychiatric diagnostic interview examinations

Provider Requirements and Contacts

Prior Authorization

Prior authorization/notification may be required

Notification of admission or preauthorization may be required for some behavioral health outpatient professional services. Contact Blue Cross & Blue Shield of Rhode Island's (BCBSRI) Behavioral Health Utilization Management at 800-274-2958. Transcranial Magnetic Stimulation (TMS) and certain services require either a notification of admission (in‑network) or authorization (out‑of‑network) through BCBSRI Behavioral Health Utilization Management as noted.

TMS: requires notification/authorization as specified in coding notes.
For in‑network services some procedures require notification of admission; out‑of‑network services require prior authorization.

Documentation Required

Contact provider call center; do not bill members for non‑covered/not medically necessary services without agreement

For member‑specific benefits and eligibility, providers must contact the BCBSRI provider call center. Providers may not bill members for services determined to be not medically necessary (or for some non‑covered benefits) unless the member was informed and agreed in advance to continue treatment at their own expense.

Definitions and Documentation Standards

Credentialed behavioral health clinicians — list of clinician types credentialed for services

PsychiatristsMD, DO

Psychiatric NeurologistMD, DO

Clinical Nurse Specialist (CNS)Credentialed

Child/Adolescent PsychiatristMD, DO

Nurse Practitioner - Behavioral Health (NP)Credentialed

Physician Assistant - Behavioral Health (PA)Credentialed

PsychologistsPhD, PsyD

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Outpatient Professional Services - Payment Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date01|01|2022

Next Review DateN/A

Key ActionNotify BCBSRI Behavioral Health Utilization Management at 800-274-2958 for admissions or preauthorization when required.

SourceLink

On This Page

Call the provider call center for member‑specific benefit information.
Do not bill members for services deemed not medically necessary unless the member was informed and agreed in advance; refer to provider participation agreement for details.

Licensed Independent Clinical Social Workers (LICSW)Credentialed

Licensed Mental Health Counselors (LMHC)Credentialed

Licensed Marriage and Family Therapists (LMFT)Credentialed

Licensed Behavior Analysts (LBA)Credentialed

Documentation Standards — reference to Behavioral Health Medical Record Documentation attached document

Standards documentBehavioral Health Medical Record Documentation standards are provided in an attached document referenced by this policy

Where to findSee the attached Behavioral Health Medical Record Documentation document for required record content

PurposeProvides medical record documentation requirements for behavioral health services

Medical policy / benefits precedence — informational only; benefits determined by subscriber agreements or evidence of coverage

Policy purpose vs benefitsThis medical policy is informational and is not a guarantee of payment; benefits and eligibility are determined by the member's subscriber agreement or member certificate or the employer agreement

PrecedenceSubscriber agreements, member certificates, and employer agreements supersede the provisions of this medical policy

Member-specific inquiriesFor member-specific benefits, contact the provider call center as noted in the policy