Coordinate care, and get paid too?!

They don’t pay you to coordinate care – do they?

Yes, Medicare does. And in 2024, they plan to improve the rates for it, too. There are codes specifically for care management services for behavioral health conditions.

Behavioral Health Integration codes

Psychiatrists, nurse practitioners, and other prescribers who bill evaluation & management (E/M) codes: use 99484. Psychologists and master degree clinicians: use G0323.

The codes differ, but the rules are the same. For each client billed, the clinician must document at least 20 minutes per month of any of the following activities:

  • Evidence of treatment planning and revision based on ongoing monitoring and progress.
  • Utilize validated rating scale(s) for initial assessment and follow-up. This could include the PHQ-9, GAD-7, etc.
  • Coordination of treatment with other involved professionals.
  • Continuity of care with an appointed care manager or member of a care team.

Click here for more information.

Will private payers follow suit? Possibly. They do tend to follow CMS’s lead (sometimes). Unless they’ve been paying lip service, behavioral health integration, especially with primary care, has been a stated goal of managed care for decades now.

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Why not try including it in your billing? Copays/coinsurance might apply, so be sure to inform your client first and obtain their consent. You never know…you might get paid a bit extra. “May the odds be ever in your favor…”

Just make sure your documentation includes the above activities, plus the time spent on each. You don’t have to do them ALL – you just have to do up to 20 minutes of at least one of the above. Or, more than one of the above, totaling at least 20 minutes.

Note: 99484 and G0323 are NOT the same thing as Collaborative Care Management, usually abbreviated CoCM. 99484 and G0323 are referred to as “general” Behavioral Health Integration.

Collaborative Care Management

Collaborative Care Management is something more intensive. It originated in psychiatry, due to the relative shortage of psychiatrists, particularly in rural areas. Mostly, it is still the domain of psychiatrists and other prescribing professionals, such as PMHNPs (psychiatric nurse practitioners). Payment for CoCM was approved by Medicare in 2017 and private payers have followed suit, as more evidence accumulated to support the positive outcomes of this approach.

In CoCM, the prescriber acts as a consultant to a primary care provider/group. The PCP continues to treat the patient, and when psychiatric medication is prescribed, the psychiatric consultant reviews the chart and offers guidance, as needed.

There is room in this model for non-prescribing clinicians, as well. Billing for CoCM requires that there be a Behavioral Health Care Manager on the team. This person is usually a doctoral or master-level mental health professional, although nurses may be used as well. Typically, the behavioral care manager is an employee of the primary care practice; however, if this is of interest to private practitioners, it may be worth investigating to see if this role is billable from your private practice setting.

Best of all??? The billing is handled by the primary care group! If the psychiatric consultant and/or the behavioral care manager is in private practice, they get paid through a contract with the primary care group – not directly from the insurance company or Medicare.

Fewer hassles with insurance, and direct referrals from a primary care office: sounds like a pretty good deal! I can’t think of a downside, and best of all, the clients get the benefit of improved care coordination and outcomes.

Susan Frager | PsychBilling Coach

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