Outpatient Provider Incentive Program for Behavioral Health Follow-up Visit

December 17, 2020

We invite you and your group to take part in our temporary Outpatient Provider Incentive Program. You may receive financial incentives for follow-up visits with our members after an acute mental health admission. The follow-up visit must be within thirty days of discharge.

Eligible visits
You will be eligible to earn $30 per claim if the visit is:

  • Between March 4, 2020 and Dec. 31, 2021
  • Within thirty days after discharge from an acute mental health admission
  • Psychotherapy or pharmacologic management (PLEASE NOTE THIS CAN BE A TELEHEALTH VISIT)
  • Member is NOT a Medicare or Medicare Supplement member

How to submit a claim for an eligible follow-up visit using CMS 1500

  • Use procedure code G9002
  • Use the modifier U9 in the modifier section
  • Use the code and modifier only once for the same member within a 30-day period
  • Only one provider may use the code and modifier for the same member within the same thirty-day period

If more than one provider uses the code and modifier for the same member, we will allow the incentive for the provider with the earlier date of service only.  Any reimbursement will be made according to BCBSNM medical and reimbursement policies.

Program limitations
Blue Cross and Blue Shield of New Mexico may extend, discontinue or change this program at any time. We will tell you if we do.

Program rules
By submitting procedure code G9002 with modifier U9 on the claim, your organization is representing to BCBSNM that the terms and conditions of this letter for use of the procedure code and modifier are agreeable and have been met. Your organization is also consenting to possible selection for a random audit to confirm the members for whom claims with the procedure code and modifier were seen within thirty days post-discharge, along with general medical record quality elements to include, without cost to BCBSNM for any copies, signed consent, biographical data, documented diagnosis, service dates, medication information, treatment plan, and confidentiality safeguards.

Please note: This incentive replaces any similar incentive for Blue Cross Community Centennial members as of March 4, 2020. The incentive amount is now $30 per claim.

More Information
For questions and comments, please email the BH Quality Improvement Team or contact your Provider Network Representative.