Take Advantage of New Revenue Opportunities for Behavioral Health Services

by | Last updated May 15, 2023 | Published on Sep 25, 2017 | Specialty Coding

Behavioral Health
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Treating mental illness is no longer separate from treating physical illness. Behavioral Health Integration (BHI) is a widely accepted strategy for improving the outcomes of people with mental or behavioral health conditions. In January 2017, the Centers for Medicare and Medicaid Services (CMS) introduced new BHI and Psychiatric Collaborative Care Model (CoCM) codes. Medical coding companies are helping primary care providers and others take advantage of the reimbursement opportunities presented by these new G-codes by ensuring that all requirements are satisfied and documented to meet billing and compliance requirements.

The collaborative care model was developed at the Advancing Integrated Mental Health Solutions (AIMS) Center of the University of Washington and has been proven effective in more than 80 randomized, controlled trials. CMS points out that it enhances typical primary care by adding two key services:

  • Care management support for patients receiving behavioral health treatment
  • Regular psychiatric inter-specialty consultation to the primary care team, particularly regarding patients whose conditions are not improving

Four new codes were created: three codes to describe services furnished as part of the Psychiatric CoCM and one code to address other BHI care models. Besides primary care providers, physician specialists can also use the new G-codes. For instance, CMS says cardiologists may use the codes for patients who suffer from depression following a heart attack and oncologists may offer BHI services to patients undergoing cancer treatment.

Four New BHI HCPCS Codes

Three Codes for Psychiatric Collaborative Care Management

  • G0502 – Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP with the following elements:
    • Outreach to and engagement in treatment of a patient directed by the treating physician or other QHP
    • Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan
    • Review by the psychiatric consultant with modifications of the plan if recommended – can be done by video or conference call
    • Entering patient information into a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant
    • Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies
  • G0503 – Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional with the following required elements:
    • Tracking patient follow-up and progress using the registry, with appropriate documentation
    • Participation in weekly caseload consultation with the psychiatric consultant
    • Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers
    • Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant
    • Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies
    • Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
  • G0504 – Initial or subsequent psychiatric CoCM, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultations with a psychiatric consultant and directed by the treating physician or other qualified health care professional.

Billing G0502, G0503 and G0504 – Points to Note

  • Three professionals are involved:
    • Primary Care Physician: supervises and oversees the care/plan
    • Psychiatrist: does not have to be an employee, but should have an established contract with the physician or group
    • Behavioral Care Manager: should be selected based on the clinical skills needed though there are currently no defined credentials for this
  • The time counted is the time of the care manager
  • Services are billed once per calendar month by the primary care physician

One New Code for Care Management for Behavioral Health Conditions

G0507 – at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  • Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
  • Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes
  • Facilitating and coordinating treatment such as psychotherapy pharmacotherapy counseling and/or psychiatric consultations
  • Continuity of care with a designated member of the care team

Billing G0507 – Points to Note

  • Time is counted by clinical staff time
  • This code can be only billed once a month
  • Services provided must involve assessment, planning and provision of interventions

All of the BHI service codes (G0502, G0503, G0504 and G0507) require an initiating visit that is separately billable, as well as prior beneficiary consent.

The results from the Substance Use Motivation and Medication Integrated Treatment published in JAMA Internal Medicine suggest that collaborative care is superior to standard care for opioid use disorder. It’s important that physicians billing for these services understand how these models lead to better patient outcomes and reduce healthcare costs. Outsourcing medical billing and coding can optimize reimbursement for collaborative care services.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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