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Understanding Behavioral Health CPT Codes and Billing Requirements

Behavioral Health Integration (BHI) programs expand access to behavioral healthcare and improve clinical outcomes by incorporating psychological assessments, substance abuse consultations, depression screenings, and many forms of ongoing mental healthcare into primary care facilities.  

Recognizing the value of accessible behavioral health services, CMS has introduced reimbursement opportunities for providers delivering BHI and psychiatric care. To maximize these reimbursements, healthcare professionals must understand CMS requirements, CPT codes, and common billing pitfalls. This article breaks down behavioral health CPT codes, detailing their definitions, restrictions, and qualifications, along with strategies to help ensure your program’s success.

What are the most common BHI CPT codes?

BHI CPT codes generally fall under three broad categories: initiating consultations, General Behavioral Health, and Collaborative Care Management (CoCM). 

Initiating consultation CPT codes:

• G0402: Welcome to Medicare / Initial Preventive Physical Exam
• G0438: Initial Annual Wellness Visit
• G0439: Subsequent Annual Wellness Visits
• G0468: FQHC IPPE or AWV
• 99495 / 99496: Face-to-Face Transitional Care Management Services
• 99202-99205: Levels 2-5 E/M Visits
• 90791: Psychiatric Diagnostic Interview

Initiating consultations are only billed once and usually include the patient’s physical health, medical history, and mental health. All patients must receive one of these introductory appointments before a provider can begin billing BHI services for a patient. Patients must also explicitly receive clinical guidance on their behavioral health conditions for the appointment to be considered an initiating consultation. 

After an initiating consultation occurs, practices should bill their BHI services under the codes that most appropriately reflect their BHI models and the services they administer.

General BHI CPT codes

• 99484: General Behavioral Health Integration for Care Management Services
• G0323: General BHI Billing for Licensed Independent Social Workers & Clinical Psychologists
• G0511: Care Management for Rural Health Clinics and Federally Qualified Health Centers (ending July 1, 2025) 

CoCM CPT codes: 

• 99492: (Initial Psychiatric Collaborative Care Management)
• 99493: (Follow-Up Psychiatric Collaborative Care Management)
• 99494: (Additional Time for Initial and Subsequent Psychiatric Collaborative Care Management)
• G2214: (Additional Time for Initial and Subsequent Psychiatric Collaborative Care Management) 

CoCM is designed for patients with more complex mental health conditions that require more involved care plans and greater clinical resource dedication over extended periods. BHI CoCM requires personalized, patient-centered care plans and ongoing mental health assessments and evaluations of treatment efficacy. A practice cannot bill for both General BHI and CoCM in the same month for the same patient. 

Learn more: Integrated Behavioral Health: An Introductory Guide for Providers

Navigating BHI CPT codes for care management programs

Care management services aim to unite patients and providers in a collaborative, high-quality journey that reduces medical costs and elevates healthcare quality. Care management programs, like Behavioral Health Integration (BHI) and Chronic Care Management (CCM), facilitate improved clinical outcomes by educating patients, actively engaging them in their care, and keeping them adherent to care plans between appointments.

These programs not only improve patient outcomes but also create recurring revenue opportunities. To access CMS reimbursements, practices must adhere to documentation requirements, follow CMS guidelines, and use the correct CPT codes.

Learn more: A Provider’s Guide to CCM: Benefits, Requirements, and Reimbursements 

CPT Code 99484 (General Behavioral Health Integration for Care Management Services)

CPT code 99484 covers 20 minutes of clinical staff time devoted to care management services for patients with general behavioral health conditions. This code covers recurring, monthly appointments provided to patients engaged in ongoing BHI services operating under the general supervision of a provider. Because 99484 can be performed under general supervision, the services can be offered by care managers or nurses. The conditions covered by this code are any mental, behavioral health, and psychiatric conditions, as well as substance use disorders currently being treated by the billing provider. 

The behavioral health diagnoses can be pre-existing or made by the billing provider. The billing provider may also manage other conditions for the patient, though this is not required to bill CPT code 99484. However, the patient and provider must have an ongoing, continuous relationship. The provider must adhere to the other basic principles of BHI as delineated by CMS to receive reimbursement.

CPT code 99484 is a fee-for-service code. The 20 minutes of dedicated clinical staff time must be meticulously tracked, recorded, and submitted to CMS for reimbursement. CPT code 99484 can be billed with other Chronic Care Management (CCM) services. 

HCPCS Code G0323 (General BHI Billing for Licensed Independent Social Workers & Clinical Psychologists)

Code G0323 was introduced in 2023 to expand the types of healthcare professionals who could administer reimbursable BHI care management services. This code has the same conditions as CPT code 99484, but the care can be supervised by clinical social workers and clinical psychologists in addition to licensed providers. The hope is that code G0232 encourages broader participation in and implementation of BHI programs.

CMS emphasizes that an overseeing provider should be central to the BHI care plan’s creation, monitoring, and periodic adjustments. However, other behavioral healthcare professionals can supervise or distribute monthly care to patients and bill their services under code G0323.   

G0511 (Care Management for Rural Health Clinics and Federally Qualified Health Centers)

Code G0511 encompasses various care management services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), including BHI and CCM services. To bill G0511, RHCs and FQHCs must provide patients with 20 minutes of dedicated behavioral health services following the guidelines established for CPT code 99484. Reimbursement rates for these clinics are higher to help these providers recoup the costs of integrating behavioral health and care management services and encourage program participation. 

However, G0511 will no longer be a code on July 1, 2025, and RHCs and FQHCs will begin billing care management services individually, as traditional practices do. At that point, they will need to switch to billing 99484 for General BHI. 

CPT Code 99492, 99493, & 99494 (Psychiatric Collaborative Care Management) 

CPT Codes 99492-99494 cover psychiatric Collaborative Care Management services. Under the CoCM model, patients are onboarded via a 70-minute consultation directed by the patient’s healthcare provider and a certified psychiatric consultant. This initial consultation is billed under CPT code 99492. This code can be billed only once and must be submitted during the initiatory phase of the patient’s BHI journey. 

After the consultation, the patient will then be assigned a dedicated care management team to facilitate the success of their behavioral health plan and monitor progress. These subsequent visits with care managers are 60 minutes in length and should be billed using CPT code 99493. 

Some cases require more intensive resources and investment from providers. If a patient needs an additional 30 minutes of BHI services, this can be billed under CPT code 99494. This code can be billed in tandem with both 99492 and 99493.

Other behavioral health CPT codes

There are many behavioral health services providers can offer that are eligible for CMS reimbursement that do not fall under BHI care management programs, like CoCM and General BHI. These services are often precursors to more involved, collaborative models of behavioral healthcare, or they can be used as preventative care to screen for potential behavioral health conditions.

Preventative medicine, risk factor reduction, and behavioral alteration CPT codes: 

• 99401-99404: Preventative Medicine Individual Counseling 
• 99411 / 99412: Preventative Medicine Group Counseling
• 99406 / 99407: Smoking and Tobacco Cessation Counseling
• 99408 / 99409: Alcohol and Substance Abuse Screening and Brief Intervention Services 

Psychotherapy and behavioral screening CPT codes 

• 90832 / 90834 / 90837: Individual Psychotherapy Services
• 90833 / 90836 / 90838: Individual Psychotherapy Performed with E/M Service
• 90853: Group Psychotherapy Services
• 96127 / 96110 / 96161: Developmental Behavioral Screenings

Increased collaboration under Integrated Care CPT codes 

• 97151 / 97152: Adaptive Behavior Assessments 
• 97153-97158: Adaptive Behavior Treatments
• 96156-96171: Health Behavior Assessment, Reassessment and Intervention 

What are the core components required for BHI billing?

BHI is a monthly service defined by tenants established by CMS. Care providers must adhere to these core components to bill CPT codes for BHI services. 

1. Initial assessment

During the initial assessment, the provider makes a validated clinical analysis of the patient’s mental and behavioral health conditions. They can administer screenings to determine the severity of a patient’s depression, anxiety, and other common mental health conditions. 

2. Continuous, systematic monitoring 

The provider will follow up proactively and systematically with the patient using validated rating scales and a registry. During this ongoing care monitoring, providers assess the treatment adherence, tolerability, and other relevant clinical responses. They will use evidence-based interventions when appropriate.  

3. Collaborative care planning and revision

The patient and provider will engage in joint care planning to address the patient’s mental and behavioral health concerns. This can include psychotherapy, pharmacotherapy, and other targeted treatments and interventions designed to improve the patient’s individualized conditions. When a patient is not responsive to treatment plans, the care team should reassess and revise the care plan.

4. Facilitation and coordination of behavioral health treatment

The provider continues to adjust treatment as needed. This includes referrals to specialty behavioral healthcare, counseling, psychiatric consultations, and other mental health services they cannot administer in their practice.

5. Continuous relationship with a dedicated care team member     

The patient should have a single, designated provider for their behavioral health care planning and ongoing treatment. All BHI services should be funneled through this ongoing relationship, and a consistent provider should analyze the patient’s progress, efficacy, and any care plan adjustments. 

Learn more: Behavioral Health Billing Guidelines for Providers 

How to avoid common Behavioral Health billing mistakes

BHI programs can extend valuable services to patients with chronic mental health conditions. However, to open up a channel of reliable, recurring revenue for your practice, you must ensure that you are keeping accurate documentation, using the appropriate billing codes, and seamlessly integrating the program into your practice’s workflow.  

1. Keep accurate documentation

Your practice must keep accurate, precise documentation to remain compliant with CMS’s policies and ensure any potential audit can be conducted with ease. This includes clear patient consent for enrollment in BHI care management programs, documentation of the services rendered to each patient every month, updated patient care plans, and other relevant medical information. 

Partnering with a care management company can help your practice safeguard this information in a streamlined hub. Accurate and easily accessible documentation will also expedite the billing process for your administrative team.  

You should also ensure that you keep track of all the information necessary to submit claims to CMS. This includes the care providers’ National Provider Identifier (NPI) number, the date, time, and place where care was provided, and the ICD-10 codes tied to the conditions being managed by each patient. If you work with an outside organization, they can help you manage this documentation. 

2. Verify CPT codes before billing

If your practice submits incorrect or conflicting CPT codes to CMS, your claims will likely be rejected. This can cause confusion, interrupt workflows, disrupt revenue channels, and incite further complications for your practice. CPT billing is complex and can be tedious, but a meticulous understanding of each BHI CPT code’s prerequisites and parameters can help you avoid costly clerical mistakes. Many care management organizations, like ChartSpan, also offer assistance with billing. 

3. Do not double bill for separate care management programs 

Providers must record complementary preventative care services separately to maintain CMS compliance. You can bill both CCM and BHI for the same patient in the same month. However, you cannot double-bill for the same 20-minute block of time. You must track a distinct block of 20 minutes of BHI care services to receive reimbursement. 

If you are also seeking to bill CCM, you need to document an additional and discrete 20 minutes of clinical time dedicated to CCM services. Do not attempt to combine care management services into a single appointment or phone call.  

4. Integrate the program into your practice workflow

Care management programs thrive when all the members of a practice enthusiastically participate. Help your team create the conditions for success by implementing BHI services, documentation, and billing into your practice's pre-existing workflow, or by partnering with a company that can help manage these elements for you. Make sure every staff member is knowledgeable about the importance of the program and understands the required record-keeping to maintain archives that are compliant with CMS.  

Elevate your behavioral care management services with ChartSpan

ChartSpan is an industry-leading full-service Chronic Care Management (CCM) company. Each day, our team of trained, compassionate care managers connects with patients around the United States. We proudly assist eligible Medicare recipients in self-management, wellness plan adherence, reaching achievable health goals, and overcoming the numerous challenges presented by living with chronic illnesses. Our turnkey operation aids providers throughout the entire scope of CCM implementation, from patient outreach and enrollment to monthly CCM services and documentation to CPT billing assistance. 

Our commitment to excellence and quality also extends to our upcoming BHI programs. We will coordinate with care providers to facilitate comprehensive chronic healthcare coordination. We will also foster ongoing patient engagement, education, and activation, positioning your patients for longevity and optimal clinical success, and diligently support practices in delivering holistic care that addresses a patient’s mental health with empathy and gravity.   

Contact us to learn more about how our care management services can aid your practice in integrating behavioral health services into your workflow and accessing new revenue opportunities*.

*Results may vary by provider.  

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