Avicenna Medical Blog

2018 Updates to Medicare's Behavioral Health Integration Program

Posted by DeAnn Dennis on Tue, Jul 03, 2018 @ 11:00 AM

Behavioral Health Integration Program:

Behavioral health integration (BHI) was added to Medicare’s care management programs in January 2017, reimbursing physicians and non-physicians for BHI services provided to patients with mental, behavioral, or psychiatric conditions. Since the introduction of BHI, Medicare has continued to update the billing codes and expand the reimbursement opportunities for providers aiding the millions of Americans living with a mental health disorder.

Medicare's updated behavioral health program for 2018 makes payments to physicians and non-physician practitioners for BHI services furnished to beneficiaries over a specified calendar month period. The model consists of behavioral services that are categorized into the psychiatric collaborative care model (CoCM) and general BHI. The CoCM program includes CPT codes 99492, 99493 and 99494  for providing care management support to beneficiaries along with regular psychiatric inter-specialty consultation to the primary care team for beneficiaries whose conditions are not improving. All services furnished utilizing behavioral health models of care other than CoCM are billed through the general BHI CPT code 99484. Beneficiaries that qualify to receive BHI services may have any mental, behavioral health, or psychiatric condition, including substance abuse disorders.

Psychiatric Collaborative Care Services (CoCM) Billing Codes:

CoCM services are administered by a care team comprised of a billing practitioner, behavioral health care manager, and a psychiatric consultant. The initial assessment of the beneficiary is performed by the primary care team (billing practitioner and behavioral health care manager) with an initiating visit, if required, and an assessment utilizing validated rating scales. Upon completion of the initial assessment, a care plan is developed by the care team and beneficiary, and an appropriate form of treatment is determined (pharmacotherapy, psychotherapy, and/or other indicated treatments). The psychiatric consultant and primary care team are required to meet at least weekly to review the beneficiary's care plan and condition.

BHI Code Behavioral Health Care Manager or Clinical Staff Threshold Time  Billing Practitioner Time Payment for Primary Care Settings Payment for Hospitals and Facilities

CoCM First Month (99492)

70 minutes per calendar month 30 min $161.28 $90.36
CoCM Subsequent Months (99493) 60 minutes per calendar month 26 min $128.88 $81.72
Add-On CoCM (Any Month) (99494) Each additional 30 minutes per calendar month 13 min $66.60 $43.56

CPT Code 99492 reimburses 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 decides modifications should be made
  • Entering the patient in a registry to monitor their progress, and participating in a weekly caseload review with the psychiatric consultant
  • 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.

General BHI Billing Code:

The General BHI code reimburses for monthly "core" services including assessing and monitoring the care plan of beneficiaries who are not seeing a significant improvement in their condition. Unlike the CoCM, a psychiatric consultant and a behavioral care manager do not have to furnish the monthly services. The service elements may be completed by the billing practitioner, who can be physician and/or non-physician practitioner (PA, NP, CNS, CNM) that typically specializes in primary care, but may be of another specialty (e.g., cardiology, oncology, psychiatry). Similar to the CoCM, the service components of BHI include an initial assessment and administration of applicable rating scales. Following this is the formation of a care plan that involves the beneficiary and the primary care team, or a care plan revision for those beneficiaries whose condition is not improving. The model requires a continuous relationship with a designated care team member to ensure that the beneficiary's condition is adequately monitored.

BHI Code Behavioral Health Care Manager or Clinical Staff Threshold Time Billing Practitioner Time Payment for Primary Care Settings Payment for Hospitals and Facilities
General BHI (99484) At least 20 minutes per calendar month 15 min $48.60

$32.76

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

  • The use of specific validated rating scales for the initial assessment or 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

Summary:

The updated CPT codes not only create new reimbursement opportunities for those care providers furnishing behavioral health services, but also provide a higher quality of care for those living with mental health disorders.

Interested in learning more about the modified billing codes for behavioral health integration? Check out the CMS Behavioral Integration Services fact sheet and Behavioral Health Integration FAQs.

Tags: CMS / Medicare, Behavioral Health Integration / BHI, Healthcare Policy and Reform, Value Based Care, Chronic Care Management / CCM, Population Health Management, Psychiatric Care Model / CoCM