Medicare has unique medical codes for different variations of care management. These codes are referred to as CPT codes. All of them are updated yearly, so you can recheck what designation they are here.
Just go to the topic that you want (in this case it is “Behavioral Health Integration”) and then go to the PDF marked “Fact Sheet”. On this page, we will go over the General Behavioral Health Integration.
Behavioral Health Integration (BHI)
CPT code 99484 is used to bill monthly services delivered using BHI models of care other than the psychiatric collaborative care model, or CoCM, that similarly include “core” service elements such as systematic assessment and monitoring, care plan revision for patients whose condition is not improving adequately, and a continuous relationship with a designated care team member. CPT code 99484 may be used to report models of care that do not involve a psychiatric consultant, nor a designated behavioral health care manager (although such personnel may furnish General BHI services). CMS expects to refine this code over time, as more information becomes available regarding other BHI care models in use.
- Initial assessment
- Initiating visit (if required, separately billed)
- Administration of applicable validated rating scale(s)
- Systematic assessment and monitoring, using applicable validated clinical rating scales
- Care planning by the primary care team jointly with the beneficiary, with care plan revision for patients whose condition is not improving
- Facilitation and coordination of behavioral health treatment
- Continuous relationship with a designated member of the care team
CARE TEAM MEMBERS
- Treating (Billing) Practitioner – A physician and/ or non-physician practitioner (PA, NP, CNS, CNM); typically primary care, but may be of another specialty (for example, cardiology, oncology, psychiatry).
- Beneficiary – The beneficiary is a member of the care team.
- Potential Clinical Staff – The service may be provided in full by the billing practitioner. The billing practitioner may also use qualified clinical staff to provide certain services using a team-based approach. The clinical staff may include staff or contractors who meet the qualifications for the CoCM behavioral health care manager or psychiatric consultant.
Eligible conditions are classified as any mental, behavioral health, or psychiatric condition being treated by the billing practitioner, including substance use disorders, that, in the clinical judgment of the billing practitioner, warrants BHI services. The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time.