Billing for Integrated Behavioral Health: Primary Care Coding Guidelines
Integrated Behavioral Health Coding Guidelines
Behavioral Health Billing Quick Reference Sheet
Basic behavioral health coding: https://aims.uw.edu/sites/default/files/Basic_BHI_Coding_0.pdf
Basic Coding for Integrated Behavioral Health Care
Always check with your state and all payers to determine the necessary qualifications for the designated billing providers. Not all states or payers reimburse for every code.
Essential CPT Psychotherapy codes for the clinically licensed Care Manager
90791 Psychiatric evaluation without medical services
90832 16 – 37 minutes of individual counseling or family counseling (with or without patient)
90834 38 – 52 minutes of individual counseling or family counseling (with or without patient)
90837 53+ minutes of individual or family as above
90785 Psychotherapy Complex Interactive (list separately in addition to code for primary procedure)
90853 Group Therapy
Essential CPT codes for the Consulting Psychiatric Provider (face-to-face only)
90792 Psychiatric evaluation with medical services
99201-99205 EM codes for initial visit with medicine components
99211-99215 EM codes for follow up visits with medicine components EM codes can be combined with these counseling codes, if applicable
90833 16 – 37 minutes of individual counseling or family counseling (with or without patient)
90836 38 – 52 minutes of individual counseling or family counseling (with or without patient)
90838 53+ minutes of individual or family, as above
90785 Psychotherapy Complex Interactive (list separately in addition to code for primary procedure)
SBIRT Brief Intervention CPT codes, billable by Care Manager and Psychiatric Consultant
15-30 minutes Full Screening and Brief Intervention for substance misuse
99408 (Private) G0396 (Medicare) H0049 (Medicaid)
30+ minutes Full Screening and Brief Intervention for substance misuse
99409 (Private) G0397 (Medicare) H0050 (Medicaid)
Screening Codes billable by Primary Care Provider (see next page for more information)
G0444 Medicare Depression Screen – 15 minutes 96127 (Brief emotional /behavioral assessment) can be billed for a variety of screening tools, including the PHQ-9 for depression Medicare
BHI/Collaborative Care Model codes billed under the Primary Care Provider
99492 First 70 minutes in first calendar month of Collaborative Care Model (CoCM) services
99493 First 60 minutes in any subsequent calendar month of CoCM services 99494 Each additional 30 minutes in any calendar month of CoCM services
99484 A minimum of 20 minutes in one month for general BHI services
G Codes for FQHC/RHC Practices Medicare
BHI/Collaborative Care Model codes billed under the Primary Care Provider G0512 Minimum 70 min initial month and 60 min subsequent months of Psychiatric Collaborative Care services G0511 20 or more minutes/month of General Care Management, including activities previously billed as Chronic Care Management (99490 or 99487)
Billing for PHQ-9 Screening by Primary Care Provider
Medicare: Reimbursed once/year • No coinsurance or deductible for patient • Variety of screens are reimbursable, PHQ-9 is recommended for ease of administration • CPT code is G0444 – Depression Screen – 15 minutes • Must have ability to provide patients who screen positive internal services or staff-supported referral to external services • Eligible practices include primary care office, outpatient hospital, independent clinic, FQHC, and RHC
Other Health Plans: CPT Code 96127 (brief emotional /behavioral assessment) can be billed for a variety of screening tools, including the PHQ-9 for depression, as well as other standardized screens for ADHD, anxiety, substance abuse, eating disorders, suicide risk • For depression, use in conjunction with the ICD-10 diagnosis code Z13.89 (screening for depression) • Reimbursed at $6 per screen and can use up to 4 screening instruments per visit • Can be billed for initial screen as well as monitoring response to treatment, so no limit on how often it can be billed.
Billing Health and Behavior Codes
Health and Behavior codes are for the psychosocial treatment of medical problems. In order to bill for these codes the primary diagnosis addressed in the intervention must be a physical health diagnosis, i.e. insomnia, heart disease, diabetes, psoriasis, etc. • Excellent FREE tutorial at http//www.apapracticecentral.org/reimbursement/healthcodes/index.aspx
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https://aims.uw.edu/sites/default/files/CMS_FinalRule_BHI_CheatSheet.pdf
http://www.pcpci.org/resources/webinars/integrated-behavioral-health-primary-care-coding-guidelines-webinar
https://healthinsight.org/component/jdownloads/send/394-oregon-behavioral-health-resources/1560-billing-for-integrated-behavioral-health-primary-care-coding-guidelines
https://aisrmedia3.jefferson.edu/Panopto/Pages/Viewer.aspx?id=91c42344-e523-4b8c-82cd-b237ba567a88
https://innovation.cms.gov/Files/x/cpcplus-methodology-py19.pdf
https://www.aapc.com/practice-management/rvu-calculator.aspx
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Health & Behavior Codes 96150–96154
Prevention, treatment, or management of physical health/medical problems • Assessment and treatment • Psychological, behavioral, emotional, cognitive, and social factors • Not for assessing/treating MH disorders • Report 1 unit for each 15 minutes
Smoking & Tobacco Counseling 99406–99407 • Smoking and tobacco use cessation counseling • 2 cessation attempts per 12-month period • Maximum of 4 intermediate or intensive sessions per attempt • 3-minute minimum
Alcohol & Substance Use (SBIRT) 99408-99409 • Alcohol and/or substance use structured screening and brief intervention services • Must use a validated screening instrument (AUDIT/DAST) • 15-minute minimum
Behavioral Health Care Management 99484 • Initial assessment or follow-up monitoring, including the use of applicable validated rating scales • Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision of plan for patients who are not progressing or whose status changes • Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation • Continuity care with a designated member of the care team • One at least 20-min session every calendar month
Developmental screening 96110 • Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument • The provider uses a standardized form to analyze the presence of any developmental disorder using the measurable parameters of the standardized instrument
• Ages and Stages Questionnaire: Social Emotional, ASQ SE • Australian Scale for Asperger's Syndrome, ASAS • Behavior Assessment Scale for Children, BASC • Behavioral Rating Inventory of Executive Functioning, BRIEF, for Psychological Assessment • Child Development Review
• Communication and Symbolic Scales Developmental Profile, CSBS DP • Kaufman Brief Intelligence Test • Parents' Evaluation of Developmental Status, PEDS • Pediatric Symptom Checklist, PSC • Vanderbilt Rating Scales.
Brief emotional/behavioral assessment 96127 • Use of a valid screening instrument for a brief assessment for – ADHD – Depression – Suicidal risk – Anxiety – Substance abuse – Eating disorders – etc.
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