What is Behavioral Health Integration?
Behavioral health encompasses a comprehensive care management approach for patients with mental health conditions. To provide personalized care, healthcare professionals create and follow a treatment plan. They routinely monitor the patient and communicate effectively with them and other professionals involved in their mental health care.
Primary care providers are able to include behavioral and mental health screening into their practices. Through the BHI model, qualified health care professionals can provide treatment and specialty care into the patient’s primary care plan.
The key factor in behavioral health integration is the patient’s holistic treatment plan. An integrated approach to healthcare joins behavioral, physical, and social health. This approach decreases fragmentation of care, resulting in improved patient outcomes.
How do I bill for Behavioral Health Integration and General Behavioral Health Integration?
Behavioral Health Integration (BHI) mental health services consist of behavioral or psychiatric health problems including anxiety and depression, for example. Substance abuse disorders also qualify for BHI services. Medicare (CMS) requires at least one psychiatric health condition be present to bill BHI.
Behavioral Health Integration bills monthly. The criteria below lists the required components:
- Assessment
- Care Plan
- Continuous Monitoring
- Behavioral Health Treatment and Care Coordination
- Continuity of care provided by a designated care team member
- 20 minutes of non face-to-face time per patient per month
- Certified Electronic Health Record (EHR)
The primary care provider oversees the care. Many times, a therapist or psychiatrist provides focused mental health care, in conjunction with the primary provider. The treatment team may also includes a specific team member.
General Behavioral Health Integration (GBHI) services allow Clinical Social Workers and Clinical Psychologists to bill for BHI. This expanded service allows a greater population outreach for treatment of mental health conditions.
CPT Codes for Behavioral Health Integration and General Behavioral Health Integration
99484 CPT Code
- A Chronic Care Management (CCM) code specifically for Behavioral Health or Mental Health conditions.
- Use this code to bill for monthly management of patients with chronic mental health conditions once an initial assessment is complete.
- Implementation, continuous monitoring of the care plan and patient communication is crucial.
- Bill this code for at least 20 minutes of provider, QHC, or clinician time per patient per calendar month.
- Clinical staff conduct the care management services remotely, under general supervision. Supervision is by a provider or qualified health care professional (QHC).
- These behavioral non-face-to-face services are for therapy management and coordination in between office visits or telemedicine visits.
G0511 HCPCS Code
- Only Rural Health Clinics (RHC) or Federally Qualified Health Clinics (FQHC) use HCPCS code G0511 to bill for BHI.
- RHCs and FQHCs use this code to bill for services like Chronic Care Management, General Care Management, or Behavioral Health Integration.
- Bill this code for at least 20 minutes of provider, QHC, or clinician time per patient per calendar month.
- Behavioral health care planning by primary care team with the patient. This includes revision for patients who are not progressing or whose status changes.
- Clinical staff conduct the care management services remotely, under general supervision. Supervision is by a provider or qualified health care professional (QHC).
- These behavioral non-face-to-face services are for therapy management and coordination in between office visits or telemedicine visits.
Psychiatric CoCM Codes: 99492, 99493 and 99494
Psychiatric Collaborative Care Model (CoCM) adds 2 extra services to the patient’s primary billing practitioner. This team consists of the primary billing practitioner, a care manager and a psychiatric consultant.
The psychiatric consultant, mental health consultant or a psychiatrist collaborate regularly. These consultants routinely meet with the primary care team to discuss patients’ conditions, adjust treatment plans, monitor, and provide recommendations.
The following Psychiatric CoCM codes used are:
CPT code 99492
- This is a code used to bill the initial psychiatric collaborative care management services the first month.
- CPT code 99492 requires 70 minutes of the behavioral health care manager or clinical staff time per calendar month.
- Or CPT code 99492 requires 30 minutes of the billing practitioner’s time per calendar month.
CPT code 99493
- This is a code used to bill for each additional month of psychiatric collaborative care management services. Use this code after the initial first month.
- CPT code requires 60 minutes of the behavioral health care manager or clinical staff time per patient per calendar month.
- Or CPT code 99493 requires 26 minutes of the billing practitioner’s time per patient per calendar month.
- Deliver CoCM monthly for an episode of care that ends when the patient meets their goals. The episode of care also ends when the patient fails to meet their goals and a referral to a psychiatrist results. If there is a break in the episode of care (no CoCM for 6 consecutive months) the episode of care ends.
CPT code 99494
- This is an add-on code to CPT code 99493. You can use this code for any month of CoCM billing. It is for extra time beyond the required time in Code 99492 or CPT code 99493.
- CPT code 99494 requires each additional 30 minutes of the behavioral health care manager or clinical staff time. This is per patient per calendar month.
- Or CPT code requires 13 minutes of the billing practitioner’s time per patient per calendar month.
What is the 2023 Additional Code for General Behavioral Health Integration G0323?
- The General Behavioral Health Integration (GBHI) billing code is G0323.
- Clinical Psychologists and Clinical Social Workers bill for managing behavioral health conditions with this code.
- Code G0323 requires at least 20 minutes of the clinical psychologist or clinical social worker time per patient per calendar month.
- GBHI does not require a psychiatric consultant or care manager like the CoCM codes 99492, 99493, and 99494.
How do you Bill with Chronic Care Management with Behavioral Health Integration CPT Code 99484?
If you meet specific requirements, you can bill Chronic Care Management (CCM) codes with Behavioral Health Integration (BHI) Codes each month. The patient must consent to both services in advance. Both services require a separate care plan. Time and effort are not counted more than once.
To bill Behavioral Health Integration (BHI) review the following criteria:
- Initial assessment, including applicable rating scales.
- Behavioral Health Care Plan, with at least one behavioral or psychiatric health condition.
- Continuous monitoring of the treatment plan, with revisions as needed.
- Coordination of treatment such as counseling, psychotherapy, psychiatric consultation or pharmacotherapy.
- Continuity of care provided by a designated care team member.
- Bill CPT code 99484 for at least 20 minutes of provider, QHC, or clinician time per patient per calendar month.
- Clinical staff conduct the care management services remotely, under general supervision. Supervision is by a provider or qualified health care professional (QHC).
- These behavioral non-face-to-face services are for therapy management and coordination in between office visits or telemedicine visits.
To bill CCM review the following criteria:
- Two or more chronic conditions expected to last at least 12 months (or until the death of the patient).
- These conditions must pose a significant risk of death, acute decompensation, or decline.
- Patients must see their provider at least once in the past twelve months.
- Personalized care plan in a certified EHR and a copy provided to the patient.
- Bill CPT code 99490 for at least 20 minutes of provider, QHC, or clinician time per patient per calendar month.
- Clinical staff conduct the care management services remotely, non face-to-face, under general supervision. Supervision is by a provider or qualified health care professional (QHC).
How Does Behavioral Health Integration Produce Revenue?
Medicare continues to expand coverage for Chronic Care Management services (CCM). Previously providers could not bill for both CCM and BHI services in the same month. New Medicare reimbursements assist primary care practices in integrating behavioral health into chronic care management services.
The Behavioral Health Integration billable CPT Code 99484 reimburses roughly $48 per patient for 20 or more minutes of time spent.
Once you multiply this among the patients that are cared for each month and subtract that by your care managers time and any related BHI software costs and computer costs the rest is for your practice to keep as profit.
The Psychiatric Collaborative Care Model (CoCM) provides billing practitioners the opportunity to increase revenue. The increased time spent on collaboration with the psychiatric consultant and the care manager may enhance reimbursement.
This model improves patient’s health by treating the physical, mental and social aspects of the patient. It also reduces costs in time, money and delays in care. Many times patients are reluctant to seek mental health services counseling, and their condition declines.
Research has shown that integrated behavioral health improves depression scores and enhances the experiences of both patients and physicians. Some studies have also demonstrated cost savings from lower rates of emergency department visits and improved health outcomes.
How do I Use Care Management Software to provide Behavioral Health Integration?
Not all Care management software can be used to provide behavioral health integration. It is helpful to find a software with a behavioral health integration component built with the proper templates created to make sure the clinical staff are documenting the full scope of services to bill CPT Code 99484 and any assessments you would like to have completed for the patient as part of their call or treatment plan.
