ModifiedBlue Cross Complete of MichiganPolicy N/A

Mobile Crisis and Crisis Stabilization for Behavioral Health

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This enhanced Medicare Advantage PPO benefit governs coverage, payment conditions, provider requirements, billing, and member cost sharing for mobile crisis intervention and crisis stabilization services for eligible Medicare Plus Blue Individual and Group PPO members whose plans include the benefit.

Policy Summary

PayerBlue Cross Complete of Michigan

PolicyMobile Crisis and Crisis Stabilization for Behavioral Health

Policy CodePolicy N/A

Change TypeModified — eligible providers now include M.D., D.O., and psychotherapist

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit claims with the applicable CPT/HCPCS and diagnosis codes at the highest level of specificity and include the provider's National Provider Identifier on every claim.

SourceLink

POLICY UPDATE CHANGES

The eligible provider condition was updated to include M.D., D.O., and psychotherapist.

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ModifiedBlue Cross Complete of MichiganPolicy N/A

Mobile Crisis and Crisis Stabilization for Behavioral Health

Customize your policy alerts

Sign up for all blue_cross_complete_of_michigan policy alerts

Know when blue_cross_complete_of_michigan releases new policies or updates existing guidance.

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Policy Summary

PayerBlue Cross Complete of Michigan

PolicyMobile Crisis and Crisis Stabilization for Behavioral Health

Policy CodePolicy N/A

Change TypeModified — eligible providers now include M.D., D.O., and psychotherapist

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit claims with the applicable CPT/HCPCS and diagnosis codes at the highest level of specificity and include the provider's National Provider Identifier on every claim.

SourceLink

POLICY UPDATE CHANGES

The eligible provider condition was updated to include M.D., D.O., and psychotherapist.

Covered service codes

2 unitsS9485 maximum per rolling week

30 daysH2011 maximum service period

F01-F99Eligible diagnosis range

Not coveredOriginal Medicare coverage

Coverage Eligibility and Payment Conditions

Initial Coverage Eligibility

Covered when all applicable benefit, clinical, provider, location, diagnosis, and frequency conditions are met.

Enhanced benefit eligibility: The member is enrolled in a Medicare Plus Blue Individual or Group PPO plan that includes the mobile crisis and crisis stabilization enhanced benefit.

Original Medicare does not cover these services.

Behavioral health crisis need: The member is experiencing escalating emotional symptoms, behaviors, or traumatic circumstances that have compromised the member's ability to function at baseline within family, living, work, or community environments.

Services and treatments necessary to provide crisis stabilization may be included.

Covered service type

Mobile crisis intervention is provided by a master's-level provider and peer counselor and may include evaluation, crisis mitigation, psychiatric connection, treatment planning, family support, and referrals.
Crisis stabilization: The service provides support, services, and treatment necessary to stabilize the behavioral health crisis.

Payment Conditions

Payment is subject to all applicable conditions below.

Provider and location: The service is furnished by an eligible M.D., D.O., or psychotherapist at an outpatient psychiatric center, the patient's home, or another patient location.

Urgent care, emergency department, and inpatient hospital locations are excluded.

Diagnosis: The claim uses an eligible ICD-10-CM diagnosis from F01-F99, Mental, Behavioral and Neurodevelopmental disorders.F01-F99

Age: There is no age restriction stated for the benefit.No restrictions

Code-specific frequency

Excluded locations: Mobile crisis and crisis stabilization services are not payable when furnished in an urgent care facility, emergency department, or inpatient hospital.

Original Medicare exclusion: Original Medicare does not cover mobile crisis or crisis stabilization for behavioral health. Coverage is available only as an enhanced benefit for members enrolled in Medicare Plus Blue Individual or Group PPO plans that include the benefit. Blue Cross or the applicable group plan determines the benefit scope, reimbursement methodology, maximum payment amounts, and member cost sharing.

Covered Codes and Billing Limits

Covered CPT/HCPCS CodesHCPCSCovered

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.

Covered ICD-10 CodesICD-10Covered

F01-F99	Mental, Behavioral and Neurodevelopmental disorders.
F10-F19.99	Mental and behavioral disorders due to psychoactive substance use.
F20-F29	Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders.
F30-F39	Mood [affective] disorders.
F40-F48.9	Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders.
F50-F59	Behavioral syndromes associated with physiological disturbances and physical factors.
F60-F69	Disorders of adult personality and behavior.
F70-F79	Intellectual disabilities.
F80-F89	Pervasive and specific developmental disorders.
F90-F98.9	Behavioral and emotional disorders with onset usually occurring in childhood and adolescence.

1–10 of 11

1/2

WPSmixed

L33632	Psychiatry And Psychology Services
A56937	Psychological Services Coverage Under The Incident To Provision For Physicians And Non- Physicians - Medical Policy Article
A52434	Health And Behavior Assessment/intervention - Medical Policy Article

Novitas JEmixed

L35101	Psychiatric Codes
A57130	Psychiatric Codes

Palmettomixed

L37638	Health And Behavior Assessment/intervention
A56562	Health And Behavior Assessment/intervention
L37638	Health And Behavior Assessment
A56562	Health And Behavior Assessment

S9485 Frequency Limit

CodeS9485

FrequencyOne unit per 24 hours

MaximumUp to two units per rolling week

H2011 Frequency Limit

CodeH2011

FrequencyOne unit per 15 minutes

Limits

Provider Requirements and Denial Risks

Billing Rule

Claim and Coding Documentation

Bill mobile crisis and crisis stabilization services on the CMS-1500 (02/12), UB-04, or equivalent 837 claim form, using Medicare Advantage PPO billing requirements. Report the applicable CPT/HCPCS and diagnosis codes at the highest level of specificity and include the National Provider Identifier on every claim.

Use the applicable CPT/HCPCS codes and diagnosis codes.
Include the billing provider's National Provider Identifier on all claims.
Follow Medicare Advantage PPO unique billing requirements.

Documentation Required

Service and Treatment Documentation

Document the mobile crisis intervention or crisis stabilization services furnished, including the crisis-related assessment, intervention, stabilization, treatment planning, family support, referrals, or other support and treatment provided. Services may be delivered face-to-face or through telehealth, as applicable.

Service Context

Mobile crisis and crisis stabilization services address behavioral health crises in which escalating emotional symptoms, behaviors, or traumatic circumstances compromise a member’s baseline functioning in family, living, work, or community settings. Mobile crisis intervention may be delivered face to face or through telehealth by a master's-level provider and peer counselor, with services such as crisis evaluation and mitigation, treatment planning, family support, connection to a psychiatrist when needed, and referral to an appropriate level of mental health or substance use care. Crisis stabilization includes the support, services, and treatment necessary to stabilize the crisis and may be provided onsite at a crisis stabilization center.

Service Definitions

Mobile Crisis Intervention

ServiceMobile crisis intervention

DeliveryFace to face or through telehealth

Provider and reachProvided by a master's-level provider and peer counselor who can travel to the member's home, place of business, or other location

Crisis Stabilization

ServiceCrisis stabilization

PurposeAll support, services, and treatments necessary to stabilize a behavioral health crisis

Included settingOnsite services at crisis stabilization centers

Level of Care

Mobile Crisis and Crisis Stabilization

Medical necessity is established when the member meets the following crisis-level behavioral health criterion.

Crisis-level behavioral health need: The member is experiencing escalating emotional symptoms, behaviors, or traumatic circumstances that compromise baseline functioning in family, living, work, or community environments.

Covered Treatment Modalities

Mobile Crisis Intervention

Mobile crisis intervention is covered when all of the following service characteristics are met.

Mobile crisis intervention: Services are provided by a master's-level provider and peer counselor, face to face or via telehealth, and may include psychological evaluation, crisis mitigation, connection to a psychiatrist for medication when needed, treatment planning that encourages family intervention and support, and referrals to an appropriate level of mental health or substance use care.

Crisis Stabilization

Crisis stabilization is covered when the following service characteristic is met.

Crisis stabilization: The service includes all support, services, and treatments necessary to stabilize the behavioral health crisis, including onsite services at crisis stabilization centers.

Service Frequency Limits

S9485 Crisis Stabilization

CodeS9485

ServiceCrisis stabilization

LimitOne unit per 24 hours, up to two units

H2011 Mobile Crisis

CodeH2011

ServiceMobile crisis

LimitOne unit per 15 minutes; no unit limit per 24 hours; maximum 30 rolling days

Policy Summary

PayerBlue Cross Complete of Michigan

PolicyMobile Crisis and Crisis Stabilization for Behavioral Health

Policy CodePolicy N/A

Change TypeModified — eligible providers now include M.D., D.O., and psychotherapist

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit claims with the applicable CPT/HCPCS and diagnosis codes at the highest level of specificity and include the provider's National Provider Identifier on every claim.

SourceLink

On This Page

S9485: One unit per 24 hours, up to two units per rolling week.1 unit/24 hours; maximum 2 units/rolling week

Crisis stabilization.

H2011: One unit per 15 minutes, with no unit limit per 24 hours, up to 30 rolling days.1 unit/15 minutes; maximum 30 rolling days

Mobile crisis.

No unit limit per 24 hours; up to 30 rolling days

Document the services and treatments necessary to provide crisis stabilization.
Record applicable crisis mitigation, psychological evaluation, treatment-plan, referral, and care-connection activities.
Identify whether services were provided face-to-face or via telemedicine when applicable.

Documentation Required

Claim Submission and Medical-Record Support

Review applicable Blue Cross reimbursement policies before submitting a claim and bill covered services in accordance with those policies. Submit electronic or paper claims to the appropriate local Blue Cross plan and provide any required supporting records.

Michigan providers may use the Blue Cross EDI 837/835 companion documents and send paper claims to the designated Detroit mailing address.
Providers outside Michigan should contact their local Blue Cross plan for electronic billing and paper-claim instructions.

Documentation Required

Provider Manual Requirements

Contracted providers should review the applicable BCBSM or BCN Medicare Advantage provider manual for additional claim-submission requirements before billing.

Denial Risk

Confirm Member and Region Eligibility

Confirm that the member is enrolled in a Medicare Plus Blue Individual or Medicare Plus Blue Group PPO plan that includes this enhanced benefit and that the service is furnished in an approved region or county. Coverage, reimbursement, payment limits, and cost sharing may vary by individual or group benefit selection.

Benefit eligibility is limited to qualifying Medicare Plus Blue Individual or Group PPO members.
Verify that the member's region or county is approved for the benefit.
Verify eligibility and cost sharing through the provider portal or by calling 1-866-309-1719.

Denial Risk

Excluded Service Location

Services are payable only in the specified outpatient settings, such as an outpatient psychiatric center, the patient's home, or another eligible location. Claims may be denied when services are provided in an urgent care center, emergency department, or inpatient hospital.

Payable locations: outpatient psychiatric center, patient's home, or eligible patient location.
Excluded locations: urgent care, emergency department, and inpatient hospital.

Denial Risk

Diagnosis and Frequency Restrictions

Confirm that the diagnosis and service frequency satisfy the policy's payment conditions. Claims may be denied for diagnoses outside the specified ICD-10-CM range or for services exceeding the applicable frequency limits.

Diagnosis restriction: ICD-10-CM F01-F99, Mental, Behavioral and Neurodevelopmental disorders.
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.

Prior Authorization

Obtain a Coverage Determination Before Uncertain Services

If there is any question whether an item or service is covered, obtain a coverage determination from Medicare Plus Blue before furnishing it. Do not use an Advance Beneficiary Notice of Noncoverage to shift responsibility for these noncovered items to the member; if a potentially noncovered item is furnished without a prior determination, the member must be held harmless except for applicable cost sharing.

Providers may not have members sign an Advance Beneficiary Notice of Noncoverage for this purpose.
Seek a coverage determination before providing an item or service with uncertain coverage.
The member must be held harmless for charges when a noncovered item was provided without first obtaining a coverage determination.

Note

Member Benefit Terms Govern Coverage

Individual member benefit documents govern coverage and payment, including applicable inclusions, exclusions, restrictions, cost sharing, and benefit limits. Review the member's Evidence of Coverage and Annual Notice of Change because the enhanced benefit policy does not guarantee coverage or payment.

Collect only the applicable Medicare Plus Blue cost-sharing amount.
A member who elects a noncovered service is generally responsible for the full charge, subject to the prior-determination and hold-harmless requirements.
Cost sharing under this benefit does not count toward the individual plan deductible or combined maximum out-of-pocket limit when the Evidence of Coverage so provides.

Documentation Required

Supporting Documentation for Noncontracted Providers

Noncontracted providers may be required to submit documentation supporting billed claims, including applicable medical records or other records requested by the plan. Ensure the submitted documentation supports the services, diagnoses, and charges reported on the claim.

Submit medical records or other supporting documentation when requested.
Documentation requirements may apply in addition to standard claim-form and coding requirements.