Behavioral health integration coding
Family physicians care for the whole patient, including mental and behavioral health.
Behavioral health integration (BHI) coding allows you to receive payment for care management services that address patients’ mental and behavioral health needs within primary care.
of primary care visits include mental or behavioral health components
BHI coding questions answered
What are behavioral health integration services?
BHI services recognize the extra time and coordination needed to care for patients with mental, behavioral health or psychiatric conditions. When providing BHI services, the patient’s health care team develops a care plan and coordinates treatment across the health care system.
CMS pays for two types of BHI services:
- General BHI
- Collaborative care management (CoCM)
What is the CPT code for general BHI services?
General BHI codes apply when clinical staff provide care management activities under the direction of a physician or other qualified professional. The general BHI code is:
- 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?
CoCM codes are used when a behavioral health care manager and a psychiatric consultant work with the primary care team to deliver coordinated care. The CoCM codes include:
- 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 or 99493)
- 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?
Both general BHI and CoCM require a systematic approach to assessment, care planning and ongoing support. Each offers monthly time-based services, including:
- 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
The difference between general BHI and CoCM lies in the staffing and level of behavioral health expertise. General BHI services can be provided by clinical staff without specialized training in behavioral health, whereas CoCM requires:
- A designated behavioral health care manager with formal education or specialized training in behavioral health (e.g., social work, nursing or psychology)
- A psychiatric consultant
Comparison of CoCM and general BHI services
BHI shares common required service elements with CoCM, but has fewer requirements.
Comparison of coding requirements for CoCM and general BHI services
| Collaborative care management (CPT 99492, 99493, 99494, HCPCS G2214) |
General BHI (CPT 99484) |
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BHI shares common required service elements with CoCM, but has fewer requirements.
Can general BHI or CoCM be billed with other services in the same month?
Yes. Either BHI or CoCM can be billed in addition to chronic care management or transitional care management services in the same month, as long as you do not count the time and activities toward more than one service. However, you cannot bill BHI and CoCM for the same patient in the same month.
What is required before starting BHI services?
Before you can bill for BHI, patients who have not been seen within the past year must complete an initiating visit, which may include:
- Annual wellness visit
- Welcome to Medicare visit
- Transitional care management
- Another qualifying evaluation and management service
Are BHI and value-based care related?
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, “Innovation care delivery: Behavioral health integration and home-based primary care.”
What are the benefits of BHI?
As a family physician, you are often a patient’s first point of contact with the health care system and care for the whole patient. BHI provides payment that recognizes the extra time and coordination it takes to manage behavioral health needs as part of primary care. This support allows you to provide more complete care without adding uncompensated work.
For your patients, the benefit of BHI means easier access to mental and behavioral health support in a familiar setting. By integrating behavioral health into your practice, patients gain additional resources and support through a trusted source of care.