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RCORP - Rural Center of Excellence on SUD Prevention

Financial Summary: Behavioral Health Care Managers

There is no one-size-fits-all financial model for the Behavioral Health Care Manager (BHCM). Many practices primarily support their efforts through fee for service (FFS) billing alone, utilizing relevant behavioral health integration (BHI) codes and working directly with their local commercial health plans or self-insured employers. Some practices leverage their participation in alternative payment models (APMs)—or other value-based care contracts—to support their BHI efforts. There are many payment models to consider in addition to FFS, and no matter which you choose, the ultimate goal is sustainable delivery of high-quality care.

For ease of use we will focus particularly on the 99484 code: When the Collaborative Care Model (CoCM) codes were rolled out, Medicare also introduced an additional code for BHI services that do not conform to the specific CoCM. The 99484 code only requires 20 minutes of time per calendar month and can be delivered by a broader set of team members or the primary care provider alone. Like the CoCM codes, some specific tasks must be performed to bill the 99484 code.

State

BHCM Billing Considerations

Kentucky

 

Accepts billing the 99484 code

 

New York

New York started a Collaborative Care Medicaid Program with grant funding years before Medicare started reimbursing for the approach. Since there were no Medicare Current Procedural Terminology (CPT) codes for CoCM at the time, New York devised its own (T2022). Some elements and requirements of New York’s program, which is administered by the Office of Mental Health, differ from Medicare, including that providers are only reimbursed for managing patients with anxiety disorder, depression, or both.

Ohio

Accepts billing the 99484 code

West Virginia

Accepts billing the 99484 code

Other

All state Medicaid programs except those in Illinois, Michigan, New York, North Carolina, and Washington reimburse code 99484.

Additional Resources and Links

Advancing Integrated Mental Health Solutions (AIMS) Center

American Academy of Family Medicine

American Psychiatric Association

Collaborative Family Healthcare Association

 

References

AIMS Center. (2021, January). Quick guide on payments for behavioral health integration services: Federally Qualified Health Centers and Rural Health Clinics.

California Health Care Foundation (CHCF). (2020, September). Cracking the codes: State Medicaid approaches to reimbursing psychiatric collaborative care.

New York State Department of Health. (2021, May). Medicaid Collaborative Care Program billing guidance.