Behavioral Health Integration
Rules and Requirements

Learn how to stay compliant and
efficient in managing this valuable program
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What is BHI?

BHI integrates behavioral health care with primary care and is now widely considered an effective strategy for improving outcomes for the millions of Americans with mental or behavioral health conditions.

Medicare makes separate payments to physicians and non-physician practitioners for BHI services they furnish to beneficiaries over a calendar month service period.

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What Conditions Are Eligible?

Eligible conditions include 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.

What Is General BHI?

General BHI is a monthly service furnished using BHI models of care that 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.

Unlike the Psychiatric Collaborative Care Model, the General BHI model of care does not involve a psychiatric consultant, nor a designated behavioral health care manager (although such personnel may furnish General BHI services).

Components of General BHI

The General BHI Service Components include:

  • 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 

What Are The Requirements?

Patient Requirements

  • Eligible behavioral condition (see prior description)
  • Must consent to the BHI service
  • May have a co-pay

Provider Requirements

  • Certified EHR Technology
  • 20 minutes per patient per month, with documented time spent per patient
  • Initial assessment or follow-up monitoring, including the use of applicable validated rating models
  • Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes
  • Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling, and/or psychiatric consultation
  • Continuity of care with a designated care team member

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 (e.g., cardiology, oncology, psychiatry).

Beneficiary

The beneficiary is a member of the care team.

Potentially Clinical Staff

The service may be provided in full by the billing practitioner. Alternatively, the billing practitioner may use qualified clinical staff to provide certain services using a team-based approach. These clinical staff may (but are not required to) include a designated behavioral health care manager or psychiatric consultant.

Billing and Coding

Code 99484: $48.00

For 20 minutes of non-face-to-face care management services per patient per month.

The average single-doctor practice can generate between $6,500 and $7,000 per month through this initiative.

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