Behavioral Health Integration
Table of Contents
- BHI Overview
- Eligible Conditions
- Part B Billing/Coding BHI Services
- New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers
- Initiating Visit
- Supervision Guidelines
- Advance Consent
- Billing BHI and Chronic Care Management in the Same Month
- New for CY 2025
- Related Content
BHI Overview
Medicare makes separate payments to physicians and nonphysician practitioners for BHI services that they furnish to beneficiaries over a calendar month service period.
BHI is a type of care management service that integrates with primary care. The term behavioral health refers to the promotion of well-being and the prevention and treatment of mental health and substance use concerns. BHI is known as an umbrella term that includes mental health, substance abuse conditions, life stressors and crises, stress-related physical symptoms and health behaviors.
The integration of behavioral health and general medical services has been proven to be an effective strategy for improving outcomes for millions of Americans with mental or behavioral health conditions.
Eligible Conditions
The eligible conditions for BHI are classified as any mental, behavioral health, or psychiatric condition being treated by the billing practitioner, including substance use disorders, that, in the clinical judgment of the billing practitioner, warrants BHI services.
The diagnosis could be either pre-existing or made by the billing practitioner and also may be refined over time. Also, beneficiaries may, but are not required to have, comorbid, chronic, or other medical condition(s) that are being managed by the billing practitioner.
Part B Billing/Coding BHI Services
CMS created a code to describe general care management services for patients with behavioral health conditions, which incorporates some but not all of the principles associated with collaborative care.
CPT 99484 is used to bill monthly services furnished using BHI models of care other than CoCM that also includes the following “core” service elements:
- At least 20 minutes of clinical staff time spent per calendar month
- An initial assessment and monitoring, using validating rating scales
- Care planning and care plan revisions for patients whose condition is not improving adequately
- Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation
- A continuous relationship with a designated care team member
Keep in mind, CPT 99484 may be used to report models of care that do not involve a clinical staff, a psychiatric consultant, or a designated behavioral health care manager.
Although, the BHI service period is one calendar month, it’s not required to wait to bill the services. This is due to the fact that CMS anticipates the billing practitioner would continue furnishing services during that month, if it is medically necessary and even after the time threshold to bill BHI is met. After the completion of the minimum clinical staff service time requirements for billing are met, the practitioner may submit the claim and does not need to hold the claim until the end of the month.
Note: BHI and CoCM are not allowed to be billed for the same beneficiary within the same calendar month.
New Coding and Payment for BHI Conditions Billed by Clinical Psychologists and Clinical Social Workers
With the 2023 FR, a new G code was created to describe General BHI performed by CPs or CSWs to account for monthly care integration where the mental health services furnished by a CP or CSW are serving as the focal point of care integration.
The core service elements that must be included in order to bill HCPCS G0323 includes the following:
- At least 20 minutes spent per calendar month providing services and meet all of the following required elements which include:
- Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
- Behavioral healthcare planning in relation to behavioral/psychiatric health problems, including revisions for patients who are not progressing or whose status changes
- Facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners whom Medicare authorizes to prescribe medications and furnish E/M services, counseling and/or psychiatric consultation and
- Ongoing care with a designated member of the care team.
CPs are authorized, based on their statutory benefit category, to furnish and bill for services provided by clinical staff incident to their professional services when all incident-to requirements are met. However, as CMS highlighted in the 2023 FR, CSWs are only authorized to bill Medicare for services they furnish directly and personally. Also, since CPs and CSWs can’t bill for E/M services, CMS has indicated that CPT 90791 is the best option to serve as the initiating visit.
Initiating Visit
An initiating visit is required for new patients or beneficiaries not seen within one year prior to commencement of BHI services.
This visit is important since it establishes the beneficiary’s relationship with the billing practitioner, it ensures the billing practitioner assesses the beneficiary prior to initiating BHI services and discusses BHI w/ the beneficiary during the face-to-face visit.
BHI must be initiated by the billing practitioner during a “comprehensive” E/M visit, annual AWV, TCM or IPPE.
This face-to-face visit is not part of the BHI service and can be separately billed.
Supervision Guidelines
BHI services that are not personally performed by the billing practitioner are assigned general supervision under the MPFS.
Although general supervision does not, by itself, comprise a qualifying relationship between the billing practitioner and the other members of the care team. General supervision is defined as the service being furnished under the overall direction and control of the billing practitioner, and his or her physical presence is not required during service provision.
To improve access to behavioral health services and reduce existing barriers, CMS has made an exception on supervision requirements. Per the 2023 FR, CMS allows auxiliary personnel such as LPCs and LMFTs to provide services under general supervision incident to a physician or NPP.
Auxiliary personnel are defined as any individual who meets the following criteria:
Is acting under the supervision of a physician (or another practitioner), regardless of whether the individual is an employee, leased employee, or independent contractor of the physician (or another practitioner) or of the same entity that employs or contracts with the physician (or another practitioner).
Advance Consent
Advance consent is required prior to commencement of BHI services.
The beneficiary must give the billing practitioner permission to consult with relevant specialists, which would include conferring with a psychiatric consultant.
The billing practitioner must inform the beneficiary that cost sharing applies for both face-to-face and non-face-to-face services that are provided, although supplemental insurers may cover cost sharing. Consent may be verbal (written consent is not required) but must be documented in the medical record.
Billing BHI and Chronic Care Management in Same Month
BHI codes can be billed for the same patient in the same month as CCM as long as:
- Advance consent for both services is received and documented
- All other requirements to report BHI and CCM are met
- Time and effort are not counted more than once
New for CY 2025
These updates focus on helping patients at risk of suicide and improving follow-up care after a crisis.
Safety Planning and Crisis Care Updates
We encourage providers to use safety planning for patients at risk of suicide. To support this effort, we introduced new billing codes:
- G0560 Safety planning interventions for patients with suicidal ideation or overdose risk
- Billed in 20-minute increments when the billing practitioner performs the service
- Applies in various settings to ensure accessible crisis care
- G0544: Post crisis follow-up care
- Requires specific protocols for telephonic follow-up after emergency department discharge
- Covers up to four follow-up calls per month as part of bundled crisis care services
New Digital Mental Health Treatment Codes
Along with traditional care, digital mental health treatments are now being used to help manage behavioral health conditions.
Starting 1/1/2025
- G0552: Supply of a DMHT device, initial education, and onboarding per treatment course that supports a behavioral therapy plan
- G0553: First 20 minutes per month of treatment management, including:
- Physician or qualified professional review of patient data from the device
- Patient or caregiver communication at least once per month
- G0554: Each additional 20 minutes per month of DMHT device-related management, billed separately from G0553
Key Reporting Requirements
- The DMHT device must be FDA-approved to bill G0552
- The billing practitioner must cover the cost of getting and supplying the device
- Supplying the device must be part of the billing practitioner’s services under an ongoing treatment plan
- We allow G0553 and G0554 to be billed only if the patient is actively using the DMHT device
- We’ll monitor the use of digital mental health treatment devices to assess their impact on behavioral health care
Expanded Interprofessional Consultation Services
Six new G-codes have been added effective 1/1/2025, G0546 through G0551, for interprofessional consultation services. These codes allow billing by specialists who diagnose and treat mental illness, including:
- Clinical Psychologists
- Clinical Social Workers
- Marriage and Family Therapists
- Mental Health Counselors
These codes mirror existing CPT interprofessional consultation codes used by providers eligible for E/M visits. The codes are:
- G0546: 5 to 10 minute assessment
- G0547: 11 to 20 minute assessment
- G0548: 21 to 30 minute assessment
- G0549: 31 or more minute assessment
- G0550: Assessment with written report for 5 or more minutes
- G0551: Referral service for 30 minutes
Related Content
- Behavioral Health Integration
- MLN® Booklet: Behavioral Health Integration Services
- Behavioral Health Integration FAQs
- Care Management
Revised 7/9/2025