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Commercial and Medicare Advantage Behavioral Health Information- Chapter 12, 2020 UnitedHealthcare Administrative Guide

Commercial and Medicare Advantage Behavioral Health Information

The U.S. Preventive Services Task Force (USPSTF) recommends that PCPs screen patients for depression, substance use disorder, and alcohol misuse. If left untreated, these disorders can adversely affect quality of life and clinical outcomes. Screening for these disorders is critical to treatment since it can contribute to the patient’s readiness to change.

Depression: Patient Health Questionnaire (PHQ-9)†, CPT 99420

Alcohol Misuse: Alcohol Use Disorders Identification Test (AUDIT) or CAGE, CPT 99420

† PHQ-9 was developed by Drs. Robert L Spitzer, Janet B. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.

When doing a screening for depression in adults, remember to include the 99420 CPT Code and the ICD-10- CM Z13.89 code.

Find these screening tools and other resources online at uhcprovider.com > Menu > Resource Library > Behavioral Health Resources.

For more information on depression, alcohol use disorders, opioid use disorders and other behavioral conditions, access the Optum website providerexpress.com>> Clinical Resources > Behavioral Health Toolkit for Medical Providers. You may also email your request to BHInfo@uhc.com.

To refer a member to an Optum network care provider for assessment and/or treatment, call the number on the back of the member’s health care ID card. A link to the Optum Clinician Directory is on providerexpress.com > Our Network > Directories.

The UnitedHealthcare Preventive Medicine and Screening Reimbursement Policy notes that counseling services are included in preventive medicine services. This policy is available on UHCprovider.com/policies > Commercial (or Medicare Advantage Policies). The Preventive Care Services Coverage Determination Guideline is on UHCprovider.com/policies > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans.

For information on coverage of mental health services and preventive health services for MA members, see the Medicare Advantage Coverage Summary for Preventive Health Services and Procedures, and the Medicare

Advantage Coverage Summary for Mental Health Services and Procedures, available on UHCprovider.com/policies > Medicare Advantage Policies > Coverage Summaries for Medicare Advantage Plans.

Optum has developed online preventive health resources that offer up-to-date information and tools to support treatment of major depressive disorder, alcohol and drug use disorder and attention-deficit/hyperactivity disorder (ADHD). The preventive health website, prevention.liveandworkwell.com, includes:

  • A screening tool to help you decide whether to seek care.
  • Articles about behavioral health conditions and how they are treated.
  • A list of organizations you can contact if you want more information about a condition and its treatment.
  • Contact information for self-help groups if you want to talk with others who can provide support and encouragement.
  • Information on how to contact us if you have questions or concerns.

Substance Use Disorder Helpline

Optum offers a 24/7 helpline for care providers and patients to:

  • Identify local medication-assisted treatment (MAT) and behavioral health care providers
  • Provide targeted referrals for evidence-based care
  • Educate members/families about substance use
  • Find community support services
  • Assign a care advocate to provide ongoing support for up to six months, when appropriate

Care providers and patients can call 855-780-5955 or use the live chat feature on liveandworkwell.com > Mind & Body > Substance Use & Addiction > Drugs.

When a member receives services from more than one care provider, collaborate and coordinate effectively to help ensure care is comprehensive, safe and effective. Lack of communication may negatively affect quality patient care. For example, members with medical illnesses may also have mental health or substance use disorders. Continuity and coordination of care is important for members with severe and persistent mental health and/or substance use disorders. This is especially true when the member is prescribed medication and has:

  • Coexisting medical/psychiatric symptoms
  • Been hospitalized for a medical or psychiatric condition

Please talk to your patients about the benefits of sharing essential clinical information.

Please contact Optum if you:

  1. Want to arrange a psychiatric consultation for a member in a medical bed,
  2. Are unclear whether a behavioral health consultation is needed, or
  3. Want assistance with any needed behavioral health authorization.

Reach Optum by calling the phone number on the back of the member’s health care ID card.