Initiation of Substance Use Disorder Provider Enhanced Payment Program Blue Cross Community CentennialSM

October 20, 2021

Providers participating in Blue Cross and Blue Shield of New Mexico’s (BCBSNM’s) Blue Cross Community Centennial network may receive an enhanced payment for a follow-up visit for Blue Cross Community Centennial members with a newly diagnosed substance use disorder. The follow-up visit regarding the substance use disorder must be within 14 days of the initial diagnosis.

Eligible visit
You will be eligible to earn an additional $75 per claim if:

  • You diagnose a new substance use disorder and provide an initial follow-up visit related to substance use disorder previously diagnosed.
  • The follow-up service is within 14 days of the initial appointment in which the diagnosis of a new substance use disorder is made.
  • Member is a Blue Cross Community Centennial (Medicaid) member.
  • This enhanced payment program began September 1, 2021.

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

  • Add procedure code H0006 to your standard code(s) for the visit.
  • Use the modifier U9 in the modifier section.
  • Use the code and modifier only once for the same member annually.
  • Only one provider may use the code and modifier for the same member annually.

Program limitations
Blue Cross and Blue Shield of New Mexico (BCBSNM) may extend, discontinue or change this program at any time. We will publish notice if we do.

Program rules
By submitting procedure code H006 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 eligible, 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.

More information
For questions and comments, please email or contact your assigned BCBSNM Provider Network Representative.