Behavioral Health Integration Overview:

Medicare's behavioral health integration (BHI) program reimburses physicians and non-physician practitioners for providing BHI services to beneficiaries with mental, behavioral, or psychiatric conditions. The model consists of behavioral services that are categorized into general BHI or the psychiatric collaborative care model (CoCM).

All general BHI monthly "core" services, which include assessing the patient and constructing a behavioral health care plan, fall into the category of general BHI CPT code 99484.  The service elements may be delivered by the billing practitioner, who can be a physician and/or non-physician practitioner.

The CoCM program includes CPT codes 99492, 99493 and 99494 and requires a more integrated approach to care management, which includes the service components of general BHI,  along with regular psychiatric inter-specialty consultation to the primary care team for beneficiaries whose conditions are not improving. The psychiatric consultant and primary care team are required to communicate on a regular basis to review the beneficiary's care plan and progress.

By providing BHI services you can help improve the mental health outcomes of your patients, while generating new recurring revenue streams for your practice.

The Opportunity:

General BHI Billing Code:

BHI Code BHI Care Manager or Clinical Staff Time  Billing Practitioner Time Payment for Primary Care Settings

General BHI  (99484)

 At least 20 minutes per calendar month  15 min $48.60

 CPT Code 99484 bills for at least 20 minutes of clinical staff time overseen by a physician, or other qualified healthcare professional. The requirements to bill for this code are described below:

  • The use of specific validated rating scales for the initial assessment and follow up monitoring of the patient
  • The formation of a behavioral health care plan or modifications to an existing care plan for those patients not seeing progress in their condition
  • Facilitating treatment through psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation

Psychiatric Collaborative Care Services (CoCM) Billing Codes:

BHI Code BHI Care Manager or Clinical Staff Time  Billing Practitioner Time Payment for Primary Care Settings

CoCM First Month (99492)

70 minutes
30 min $161.28
CoCM Subsequent Months (99493) 60 minutes per calendar month 26 min $128.88
Add-On CoCM (Any Month) (99494) Each additional 30 minutes per calendar month 13 min $66.60

CPT Code 99492  is a one time code reimbursing for 70 minutes of behavioral care services furnished during the first calendar month and includes the services described below:

  • The initial assessment of the patient, which includes the administration of validated rating scales and the formation of a care plan
  • Treatment of the patient conducted by the treating physician or other qualified health care professional
  • Review and refinement of the initial care plan if the psychiatric consultant determines modifications should be made
  • Entering the patient in a registry to monitor their progress, and participating in a regularly scheduled caseload review with a designated psychiatric consultant that is a part of the patient's care team
  • Utilizing techniques including behavioral activation and motivational interviewing as focused treatment methods

CPT Code 99493 is billed for the months following the initial assessment. The first 60 minutes of care is comprised of the services described below:

  • Monitoring patient progress utilizing the registry and documenting this progress with appropriate documentation
  • A weekly caseload review with the psychiatric consultant
  • Coordination among the treating physician or other qualified health care professional and any other mental health providers involved in the beneficiary's mental health treatment process
  • Ongoing review and modification of the care plan by the psychiatric consultant
  • Continuation of focused treatment methods
  • Relapse prevention planning with the patient as their condition improves and they prepare to be discharged from treatment

CPT Code 99494 is used in conjunction with codes 99492 and 99493 for each additional 30 minutes of care provided per calendar month.

Getting Started:

AviTracks-BH is designed to help you quickly implement your BHI services program and efficiently manage your patients:

  • Implement a custom solution in days
  • No large upfront costs - just an extremely affordable monthly subscription
  • Subscription is based on number of patients, so you can start small and grow

See for yourself how easy it is to implement AviTracks-BH Behavioral Health Integration software - request a demo today!

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