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Behavioral Health Integration (BHI) /Coordinated Care Management (CoCM)

When your behavioral health patients need extra attention and even psychiatric services, the care coordination activities between primary and behavioral healthcare professionals qualify for reimbursement.

Coordinate care with behavioral health specialists when your patients need psychiatric care

The complexities of psychiatric medications and treatment plans typically require primary care physicians to refer patients to qualified behavioral health specialists. 

And as the medical community continues to advance its understanding of the tight connection between a patient’s mental and physical health, CMS is encouraging the integration of behavioral health with primary care (behavioral health integration or BHI) through the introduction of codes that support collaboration and coordination among each discipline.

The result? Patients get access to the care they need to stay on track while you get reimbursed properly for the time you take to coordinate behavioral health services and medications.

The Benefits of BHI/CoCM

  • Get reimbursed for care coordination activities between your practice and behavioral health specialists
  • Improve patient outcomes with comprehensive physical and mental healthcare
  • Prevent costly complications among your most complex patients
  • Improve the qualify of life in your chronically ill patient population

"Gaining insights and guidance from primary care physicians can sometimes be challenging. When our primary care partners are using ChronicCareIQ, it's much easier for us to stay connected and informed while also making sure each care team member is reimbursed properly."

Psychiatrist, Independent Behavioral Health Practice

How it works

How ChronicCareIQ Enables Behavior Health Integration/Psychiatric Coordinated Care Management

  1. Once patients are enrolled in your care management program, the system begins to proactively engage with them according to the clinical protocols you set for their specific chronic conditions. Engagement comes in the form of a series of simple questions that patients respond to – either on their phone, tablet, or personal computer.
  2. As your team provides care and supportive services, such as phone calls,  coordinating medication refills, and speaking with specialists, the system recognizes those interactions and automatically captures and timestamps each activity. Each eligible activity is then assigned the appropriate care management program codes. There is no need for staff to manually provide documentation or follow reimbursement guidelines for hitting certain thresholds – the system does the work for them.
  3. Your clinical team members simply review their red-yellow-green dashboards to know which patients are at risk for falling out of the guidelines you’ve set and which ones need immediate attention. They can drill down to the details of each patient, review recent interactions and see the latest data coming in from patients and/or monitoring devices. This gives them a complete picture of the patient in real-time so they can make more informed decisions about what needs to happen for each patient.
  4. Your back-office staff has access to reports that show which clinical activities were performed on which patients so preparing claims for reimbursement is simple. The system even tells them how close each enrolled patient is to fulfilling the respective CCM requirements each month.

BHI/CoCM HCPT Billing Codes (as of CMS FY2022 Fee Schedule)

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 time, per calendar month, with the following required elements:

  • Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
  • Behavioral health care planning in relation to behavioral or psychiatric health problems, including revision for patients not progressing or whose status changes
  • Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling or psychiatric consultation
  • Continuity of care with a designated member of the care team

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 that the treating physician or other qualified health care professional directs, with the following required elements:

  • Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional
  • Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan
  • Review by the psychiatric consultant with modifications of the plan, if recommended
  • Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant
  • Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies

CPT code 99493
Follow up psychiatric collaborative care management, first 60 minutes in a following 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, with the following required elements:

  • Tracking patient follow-up and progress using the registry, with appropriate documentation
  • Participation in weekly caseload consultation with the psychiatric consultant
  • Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers
  • Other review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations supplied by the psychiatric consultant
  • Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
  • Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms or other treatment goals and are prepared for discharge from active treatment

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 that the treating physician or other qualified health care professional directs

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:

  • Tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant
  • Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers
  • Other review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations supplied by the psychiatric consultant
  • Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
  • Monitoring of patient outcomes using validated rating scales
  • Relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals that are prepared for discharge from active treatment

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