Behavioral Health Integration (BHI) uses two code families: behavioral health care management (99484) for general mental health/substance use treatment, and psychiatric collaborative care (99492, 99493, 99494) requiring a psychiatric consultant. CPT 99484 (care manager, 20+ minutes per month) is used for depression, anxiety, substance use disorder without psychiatric consultation. The Collaborative Care Model (99492 initial, 99493 subsequent, 99494 additional 30 min) requires an integrated team: primary care provider, behavioral health care manager, and psychiatric consultant. Medicare pays $140-180 per month for collaborative care. Patient must consent to BHI enrollment. The service is non-face-to-face care coordination, distinct from office visits.
Bill 99484 once per patient per month for behavioral health care management without psychiatric consultation. The care manager provides 20+ minutes of care coordination, patient assessment, treatment planning, and medication monitoring. Bill 99492 (collaborative care, initial) once per episode when the patient enters the psychiatric collaborative care model. Bill 99493 for subsequent collaborative care visits. Bill 99494 for each additional 30 minutes of collaborative care. The psychiatric consultant must provide regular input via phone or EHR—cannot be absent from the team. The primary care provider remains the billing provider; the psychiatric consultant and care manager support the primary care provider's treatment. All three team members must be documented in the care plan.
Prior authorization is not required by Medicare or most commercial payers for BHI enrollment. However, patient consent must be documented. Some payers require diagnosis of depression (PHQ-9 score 10+), anxiety disorder, ADHD, PTSD, or substance use disorder to justify enrollment. Verify coverage with the patient's plan before enrollment. Collaborative care (99492-99494) faces higher scrutiny; ensure psychiatric consultant involvement is documented monthly. Payers audit for appropriate diagnosis, care coordination activities, and team collaboration. Behavioral health care management (99484) is easier to justify for common diagnoses like depression and anxiety.
BHI codes are not bundled with office E/M visits or CCM codes. The patient can be billed for BHI and CCM in the same month if both are appropriate (e.g., 99484 for depression, 99490 for diabetes + hypertension). Do not apply modifiers to BHI codes. Only one provider per patient per month bills behavioral health care management (99484). For collaborative care (99492-99494), the primary care provider bills on behalf of the team. The psychiatric consultant and care manager do not separately bill; their services are included in the primary care provider's billing.
Document patient consent for BHI enrollment (date and method). Establish a behavioral health registry tracking all enrolled patients. For each patient, maintain monthly care coordination notes showing: (1) initial assessment (diagnosis, PHQ-9 or other validated screening), (2) care manager activities (medication adherence, therapy coordination, barrier assessment), (3) psychiatric consultant input (for 99492-99494: treatment recommendations, medication review, patient response), (4) communication with specialists or therapists, (5) patient engagement and treatment response. For collaborative care, document the psychiatric consultant's monthly involvement and recommendations. Track time spent (20+ minutes for 99484, 30+ minutes for 99492, etc.). Update the care plan monthly based on patient response.
Yes. The psychiatric consultant can provide input via phone, EHR, or telehealth. In-person meetings are not required. The key is regular collaboration and documented input—typically at least monthly review of all collaborative care patients. Remote consultation reduces barriers to access.
A PHQ-9 score of 10+ generally indicates moderate depression and justifies enrollment. A score of 5-9 may be sufficient if the patient is at risk or has functional impairment. Use clinical judgment and document the severity and functional impact, not just the score.
Document the clinical improvement and the discharge plan. Notify the patient and confirm they no longer wish to enroll in BHI. Document the discharge reason in the EHR. Stop billing BHI codes. Recommend ongoing outpatient mental health care or transition to CCM if appropriate for chronic disease management.
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