Coding for Behavioral Health Integration Services

What Are Behavioral Health Integration Services?

Behavioral health integration (BHI) services provide payment for the additional care management services patients with mental, behavioral health, or psychiatric conditions receive from their primary care team. The primary care team develops a care plan and coordinates treatment across the health care system.

The Centers for Medicare & Medicaid Services (CMS) pays for two types of BHI services:

General BHI
Collaborative Care Management (CoCM)

What Is the CPT Code for General BHI Services?

Current Procedural Terminology (CPT) code 99484: care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month

What Are the CPT Codes for CoCM?

CPT code 99492: initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
CPT code 99493: subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
CPT code 99494: initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (report in conjunction with 99492, 99493)
Healthcare Common Procedure Coding System (HCPCS) code G2214: initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional

What Are the Differences Between General BHI and CoCM?

General BHI and CoCM services are monthly time-based services that include:

a systematic assessment
development and monitoring of a personalized care plan
coordination of behavioral health treatment
a continuous relationship with a member of the care team

CoCM includes additional services provided by:

a designated behavioral health care manager (must have formal education or specialized training in behavioral health, e.g., social work, nursing, or psychology)
a psychiatric consultant

Clinical staff providing care management services for general BHI are not required to have additional education or training in behavioral health.

BHI and CoCM can be billed in the same month as chronic care management or transitional care management services. However, the time and activities used to meet the criteria for another service cannot be counted toward BHI or CoCM.

BHI and CoCM cannot be billed in the same month for the same patient.

Patients who have not been seen within one year before the start of BHI services must have an initiating visit. An initiating visit can include the annual wellness visit, Welcome to Medicare, transitional care management, or other qualifying evaluation and management service.

Learn how to sustain BHI services in your practice and earn FREE CME.

Table 1. Side-by-side comparison of coding requirements for CoCM vs. general BHI services

Collaborative Care Management (CPT codes 99492, 99493, 99494, HCPCS code G2214)

General BHI (CPT code 99484)

Requirements:

Outreach to and engagement in treatment of a patient as directed by the treating physician or other qualified health care professional
Initial assessment by primary care team and administration of validated rating scale(s)
Joint care planning with the primary care team, with revisions for patients whose condition is not improving adequately
Review by the psychiatric consultant, with modifications to plan, if recommended
Proactive, systematic follow-up by behavioral health care manager using validated rating scale(s) and a registry
Regular (at least weekly) case load review with psychiatric consultant
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
Patient consent (verbal or written) documented in the medical record

Shares common required service elements with CoCM, but has fewer requirements:

Initial assessment or follow-up monitoring, including use of validated rating scale(s)
Behavioral health care planning, including revisions for patients not progressing or whose status changes
Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling, or psychiatric consultation
Continuity of care with a designated member of the care team
Patient consent (verbal or written) documented in the medical record

BHI and Value-based Care

BHI is most commonly paid under fee-for-service. The shift toward value-based payment allows practices to provide additional services, like BHI, in new and innovative ways. Learn more about different behavioral health integration models in the FPM Supplement, “Innovative Care Delivery: Behavioral Health Integration and Home-based Primary Care.”

Benefits of BHI Services for Physicians and Patients

Family physicians are often a patient’s first point of contact with the health care system and care for the whole patient. BHI offers payment to primary care teams for care management services provided to patients with mental, behavioral health, or psychiatric conditions. By integrating behavioral health with primary care, patients can receive additional support through their usual and trusted source of care.