Oct. 23, 2024
What’s new: Illinois HB 2847 (PA 103-0535) requires that all individual and group policies provide coverage for an annual mental health preventive and wellness visit for children and adults, with no member cost share. This visit is in addition to the annual preventive physical exam/well-child visit.
- For HMO plans, this mandate is effective Jan. 1, 2025.
- For other affected plans, the mandate is effective on renewal. Check eligibility and benefits to confirm details, prior to rendering services.
Purpose: Per the mandate, the annual mental health prevention and wellness visit is intended to:
- Identify any mental health issues, conditions, or disorders
- Perform evaluation of adverse childhood experiences
- Discuss mental health symptoms and overall mental health and wellness
Visit details: The visit must include age-appropriate screening recommended by the United States Preventive Services Task Force or the American Academy of Pediatrics’ Bright Futures: Guidelines for Health Supervision for Infants, Children, and Adolescents.
The visit may be covered for up to 60 minutes when conducted by a physician, licensed clinical psychologist, licensed clinical social worker, licensed clinical professional counselor, licensed marriage and family therapist, licensed social worker, or licensed professional counselor.
If rendered by a primary care provider, the visit can be combined with other services rendered by the same provider, on the same date. It can be part of an integrated primary care service delivery method, including a psychiatric collaborative care model.
Reimbursement: Use the following Current Procedural Terminology (CPT®) codes for reimbursement. The rates must be the same as for other medical care:
- 99381-99387
- 99391-99397
Reimbursement can be adjusted to pay claims that are billed by non-physician clinicians in the same manner as adjustments for other medical care.
For more information: View the bill on the Illinois General Assembly website.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.