Medicare's Integrated Behavioral Healthcare Services and Collaborative Care Program

January 18th, 2018 - Wyn Staheli, Director of Research
Categories:   Denials & Denial Management   HCPCS Coding   Medicare   Behavioral Health|Psychiatry|Psychology   Primary Care|Family Care  
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Over the last several years, primary care has begun to integrate behavioral health services to better address shortfalls in patient quality of care. Some of the first codes were the Health and Behavior Assessment/Intervention (96152-96155) codes, which were added in 2002. Since then, many different models have been experimented with and have had some positive results. Patients with chronic conditions need more follow-up than other types of patients and some new codes will allow providers to report this additional care.

Medicare created new codes in 2017 (G0502, G0503, G0504, G0507) for their new integrated care model. In the 2018 Medicare Physician Fee Schedule Final Rule, those G codes were replaced with codes 99492, 99493, 99494 and 99484. With the inclusion of these new codes in the CPT code book, it is likely that additional commercial payers will expand their coverage of these services.

To use these codes, the patient must have a diagnosed psychiatric disorder which requires ongoing assessments, treatment plan reviews, and brief interventions.

These new codes created some new provider types: behavioral health care manager and psychiatric consultant, which have distinct responsibilities in these new collaborative care models.

It is important to note that treatment without any measurement of outcomes has proven ineffective in ensuring that patients don't either fall through the cracks or stay on ineffective treatment plans longer than they should.

More comprehensive information on using these codes is included in Find-A-Code's Reimbursement Guide for Behavioral Health available in the online store.

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