What is a CPT Code?
Current Procedural Terminology (CPT codes) are numbers assigned to every task and service a provider administers to a patient, including medical, surgical, and diagnostic services. Insurers use these codes to determine the amount of reimbursement that a practitioner will receive from an insurer for that service.
What is a reimbursement?
Healthcare reimbursement describes the payment that your hospital, doctor, diagnostic facility, or other healthcare providers receive for giving you a medical service.
Behavioral Health Integration (BHI)
Behavioral Health Integration (BHI) connects behavioral and medical health providers together to collaborate with patients to address the crossing of behavioral and medical conditions that affect health and well-being. BHI aims to create one setting to address health concerns.
Behavioral Health Integration (BHI) Umbrella
There are many conditions covered under the BHI umbrella. Eligible conditions include any mental, behavioral health, or psychiatric condition, including substance use and other disorders.
What is collaborative care management (CoCM)?
Collaborative care management is a model that works to enhance care through BHI and primary care through a care team. The members of the care team typically includes:
- Treating Practitioner: Usually, a primary care provider, but can also be a provider that has a different specialty (for example, cardiology or pulmonary).
- Behavioral Health Care Manager: A designated individual who oversees BHI treatment of a patient, who works directly with the treating practitioner.
- Psychiatric Consult: A medical professional who specializes in psychiatry and is qualified to prescribe medication. This person can also give additional insight to the other members of the care team about treatment plans.
Validated Rating Scales of Behavioral Health Integration (BHI)
Care managers perform proactive and systematized follow-up care through validated rating scales. When using validated rating scales a care manager will evaluate the patient’s attachment, tolerability and response to the treatment plan based on techniques used during meetings with patients.
The main CPT Codes that are used for BHI are: 99492, 99493, 99494, 99484
BHI CPT Code
The Centers for Medicare & Medicaid Services (CMS) have established CPT codes for behavioral health integration (BHI). BHI allows for providers to check in with patients in between visits to improve quality of life and conditions.
BHI CPT Code: 99492
BHI CPT Code: 99492 handles the monthly billing of the services used, the initial psychiatric care management. It is a requirement that there are 70 minutes of care within the calendar month that is led by the care management team. The required elements of BHI care under this code include outreach and engagement directly from the provider or another qualified healthcare provider. This initial assessment of the patient’s conditions leads to the development of an individualized plan of care. This care plan is reviewed by the psychiatric team and will make modifications if necessary. From this point, a patient will engage in weekly consultations with their care team.
BHI CPT Code: 99493
BHI CPT Code: 99493 handles the subsequent care management for BHI patients. Following the first month, the patient and care management team meets for a required 60-minute check-in. This check-in is focused on motivational interviewing and other focused treatment strategies. This CPT code is used to track the progress of the patient and follow-up with them. There is also a weekly psychiatric consultation where the ongoing collaboration between providers and the care management team occurs. This consult serves as an additional review of a patients’ progress and where any care plans might be revised by the care team based on whether the patient is worsening or improving.
BHI CPT Code: 99494
BHI CPT Code: 99494 can either be the initial or subsequent care to a patient. This code is used for an additional 30-minute care in tandem with the initial 70 minutes of care or the subsequent 60 minutes of care. This code is additional care and is only seen with CPT Code: 99492 and CPT Code: 99493.
BHI CPT Code: 99484
BHI CPT Code: 99484 is used for general care management services and does not include all the services, like other BHI CPT codes. BHI CPT code:99484 is special because it does not require a psychiatric consult. This code can be billed once a patient reaches 20 minutes of care from the clinical staff, typically directed by a provider or other qualified healthcare professional (QHP). Since this code does not require a psychiatric consultation, there are required services that must be conducted under this code to determine the future BHI treatment plan for a patient. This includes either an initial assessment for the first month and follow-up monitoring for the subsequent months. The assessment and follow-up’s use validated rating scales to determine care plans. Other elements of this code include the potential for coordinating other care plans under the mental health umbrella. This treatment plan emphasizes the importance of continuity of care and improving the patient’s life through quality care.
The reimbursement billing is different for each CPT code under the BHI care umbrella and can differ depending on the care provider. The national average for each BHI CPT code is as followed:
BHI CPT Code: 99492: $90.46
BHI CPT Code: 99493: $81.81
BHI CPT Code: 99494: $43.97
BHI CPT Code: 99484: $32.80
Sources
https://aims.uw.edu/sites/default/files/CMS_FinalRule_BHI_CheatSheet.pdf
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Behavioral-Health-Integration-FAQs.pdf
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Behavioral-Health-Integration-FAQs.pdf