Mental Health

Behavioral Health Integration

Table of Contents

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Behavioral Health Integration

Behavioral health integration or BHI is an effective strategy for improving outcomes for millions of Americans with mental or behavioral health conditions. As of 1/1/2017, Medicare began making separate payments to physicians and nonphysician practitioners for BHI services supplied to beneficiaries over a calendar month service period. BHI is also a type of care management service which integrates both primary care and behavioral health care.

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General Behavioral Health Integration

The treating or billing practitioner who is treating Medicare patients with depression and other behavioral health diagnoses can deliver general BHI services to Medicare beneficiaries. General BHI services may also be delivered by the treating practitioner in its entirety or without the use of a care team.

General BHI uses the following care team members:

  • Treating (billing) practitioner – physician and/or nonphysician practitioner (physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife); typically of primary care or can be of another specialty (for example, cardiology, oncology, psychiatry)
  • Beneficiary – involved in care planning process
  • Potential clinical staff – clinical staff may be directly employed and/or contracted; staff must meet qualifications based on their role whether it is required or optional care team member
  • Care team members not required under general BHI (optional) - psychiatric consultant and behavior health care manager

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Eligible conditions

Eligible conditions for the delivery of general BHI include any mental, behavioral health or psychiatric condition(s), including substance abuse disorders, treated by the billing practitioner and in the clinical judgement of the billing practitioner warrants BHI services.

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Service Components

General BHI service components include:

  • Initial assessment
    • Initiating visit (if required, billed separately)
    • Administration of applicable validated rating scale(s)
  • Systematic assessment and monitoring, with use of applicable validated clinical rating scales
  • Care planning by primary care team jointly with the beneficiary, including revision for patients with conditions that are not improving
  • Facilitating and coordinating behavioral health treatment
  • Continuity of care with a designated member of the care team

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Billing Codes

The following billing codes are used to bill monthly general BHI services. Each billing code has specific time requirements that must be met per calendar month:

  • CPT code 99484
    • Minimum of 20 minutes per calendar month.
    • Used to bill BHI models of care other than psychiatric CoCM services.
  • CPT code G0323 - new for CY 2023
    • At least 20 minutes of clinical psychologist (CP) or clinical social worker (CSW) time per calendar month
    • Describes general BHI that a CP or CSW performs to account for monthly care integration
      • A CP or CSW service as the focal point of care integration furnishes the mental health services

Note: CPT code 90791 as an eligible initiating visit for G0323.

  • Code G0511 - (FQHC and RHC only)
    • Minimum of 20 minutes per calendar month of general care management services

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Frequently Asked Questions

  1. Why would I want to add behavioral health services to my clinical offerings?

Answer: Access to existing mental health services is severely limited, and unlikely to improve if the system continues to rely on traditional referral methods. There is substantial evidence that providing improved access to quality behavioral health care can

  • Save substantial amounts of money when managing chronic medical conditions;
  • Prevent costly hospitalizations;
  • Dramatically improve physical health outcomes; and
  • Improve clinician and patient satisfaction.

In addition, because of convenience and stigma, many patients are more willing to access mental health treatment when provided at their routine doctor’s office than at a specialty mental health clinical setting

  1. Do the BHI codes allow for BHI furnished via telehealth?

    Answer:     The BHI codes allow for remote provision of certain services by the psychiatric consultant and other members of the care team. The BHI codes do not describe services that are subject to the rules for Medicare telehealth services in the narrow meaning of the term (under section 1834(m) of the Social Security Act).
     
  2. Can the behavioral health care manager bill for psychotherapy and other similar codes separate from BHI?

    Answer:     Yes. As noted in the CY 2017 PFS Final Rule, (81 FR 80231-80232) if the behavioral health care manager is eligible to independently furnish and report services to Medicare, that individual could report separate services furnished to a beneficiary receiving BHI services in the same calendar month such as psychiatric evaluation, psychotherapy, and alcohol or substance abuse intervention services. Time spent by the behavioral health care manager on activities for services reported separately cannot be included in the time applied to any BHI service code (in other words, time and effort cannot be counted more than once).
     
  3. Which specialties can report BHI services? Can BHI be billed by specialists other than “traditional” primary care specialties?

    Answer:     The BHI codes can be billed (directly reported) by physicians and nonphysician practitioners whose scope of practice includes E/M services and who have a statutory benefit for independently reporting services to Medicare. This includes physicians of any specialty, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives. General BHI could be billed by a psychiatrist who furnished the services described by the general BHI code and met all requirements to bill it.

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Reviewed 10/10/2023