Behavioral Health Integration (BHI) is a monthly program that helps Medicare beneficiaries address mental health concerns. Covered by Medicare Part B, providers should learn what CPT billing codes are used for BHI in order to optimize care delivery and avoid denied claims.
BHI is covered for Medicare Part B patients with a small co-pay. This monthly engagement program offers patients the benefits of systematic assessments, personalized care plans, and coordination of behavioral health treatment.
BHI is reimbursable under Medicare’s Physician Fee Schedule, paying various rates.
CPT Code 99484
Billing code 99484 is for BHI care management with at least 20 minutes of allocated provider time per patient per calendar month.
BHI is primarily managed by the patient’s physician or care manager. However, a third-party psychiatric consultant or therapist may provide additional services.
About BHI and Its Billing Requirements
Medicare instituted BHI to ease the care access burden, meet patients at their comfort level, and reach a population generally attributed to be reticent about seeking mental health services.
Providers can also use the program to engage patients on a monthly basis between regular appointments.
Delivered through remote interactions, either by phone or a telehealth platform, BHI services can include:
- A systematic assessment
- Continuous patient monitoring
- Care plan creation and revision
- Facilitation and coordination of behavioral health treatment
- A continuous relationship with a designated care team member
Eligible BHI conditions include any mental, behavioral health, or psychiatric condition being treated by the billing practitioner, including substance use disorders that are deemed in the clinical judgment of the billing practitioner to warrant BHI services.
The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time. Your patient must present at least one behavioral health condition to be eligible for the program.
Individual care plans are created for, and in collaboration with, the patient upon BHI enrollment. These care plans act as a comprehensive guide to the patient’s goals and health history.
Medicare Part B will cover up to 80% of the program’s cost. Other insurances, such as Medicaid or private companies, may also cover this.
Who Can Provide BHI?
BHI billing must be directed by a provider with an NPI number. However, clinical staff can administer most of the program, saving physician time and involvement. Eligible providers include:
- Physicians
- Physician assistants
- Nurse practitioners
- Certified nurse midwives
- Clinical nurse specialists
Submitting Claims to Medicare
Five items are required when submitting a Medicare claim:
- CPT codes for each program you are managing for the patient
- ICD-10 codes tied to each of the conditions you are managing within that program
- Date of service
- Place of service (most often in-office or telehealth)
- National Provider Identifier (NPI) number
It is helpful to know the staff care coordinator assigned to a patient in case of an audit.
Four Steps to Bill for BHI
- Verify CMS requirements were met for each patient each month
- Submit claims to CMS monthly
- Send an invoice to patients receiving monthly BHI services
- Determine there are no conflicting codes that have been billed
For Rural Health Clinics and Federally Qualified Health Centers
Utilize HCPCS code G0511
Rural health clinics and federally qualified health centers utilize the following HCPCS code for "general care management” to bill for BHI.
This code can be billed in multiple instances. This includes additional 20-minute increments of BHI, and other programs, such as Remote Patient Monitoring or Chronic Care Management. However, when billing other programs, their respective requirements must be met separately.
Their associated costs must also be accounted for separately.
Like with fee-for-service codes, one ICD-10 code must be presented when billing G0511 for BHI.
BHI with Chronic Care Management
Providers can offer BHI alongside Chronic Care Management (CCM).
Providers can use CCM to engage patients on a monthly basis between regular appointments. Delivered through remote interactions, either by phone or a telehealth platform, CCM is billable when at least 20 minutes are spent with the patient performing appropriate tasks.
When supporting chronic disease management, BHI enables a collaborative care model that can improve outcomes and reduce costs.
CCM supports its own CPT billing codes, and these can be billed concurrently with BHI, supporting dual reimbursements. However, all CCM services and time requirements must be met separately from BHI.
This is also the case for rural health clinics and federally qualified health centers. These groups must use HCPCS code G0511, though.
Learn more about CCM billing codes here.
Revenue Potential of BHI
For healthcare organizations, care management programs can drive revenue and support cost savings. Below is a general example of how reimbursement for a BHI program could add up.
BHI Promotes Value-based Care
BHI programs promote value-based care by expanding access to mental health services and engaging patients through proactive care planning. Coordinating behavioral health services to support chronic condition management can improve outcomes and reduce costs.
Patients benefit from enhanced engagement, as well as access to a care manager. They have a monthly check-in to ask questions, discuss their condition, and access resources.
BHI can improve rates of screenings and assessments and aid in diagnosis, medication adherence, and resource support. Personalized care planning can be used to establish and track SMART goals, or identify social determinants of health.
A BHI program can generate significant revenue just by billing its CPT code. However, elements of the program, especially within a larger healthcare system, can also promote a value-based care model.
ThoroughCare Simplifies Behavioral Health Integration
ThoroughCare offers end-to-end workflow for Behavioral Health Integration.
We simplify the process, so providers can focus on engaging patients. ThoroughCare:
- Streamlines the creation of patient care plans
- Supports staff workflows with guided assessments
- Helps motivate patients through clinical recommendations
- Analyzes patient risk factors and generates clinical recommendations
- Tracks and logs BHI services for an audit-proof record of care
- Supports validated assessments to identify behavioral health conditions, including PHQ-9 (Depression), GAD-7 (Anxiety), CAGE (Alcohol), DAST-10 (Substance Abuse), and MDQ (Mood Disorders).
*Reimbursement rates are based on a national average and may vary depending on your location.
Check the Physician Fee Schedule for the latest information.