Additional Billing Codes

 
 
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Health and Behavior Assessment and Intervention Codes

  • Used for the prevention, treatment/management of a physical health diagnosis (e.g., diabetes mellitus, hypertension, obesity, lupus, cancer, etc).

    • Physical health diagnoses can be found in the ICD-10

  • Assess and treat patient’s psychological, behavioral, social, emotional, cognitive functioning factors that could be affecting health (e.g., treatment adherence, high risk behaviors that can jeopardize the physical health condition, health promotion, symptom management).

  • NOT for assessment and treatment of mental health disorders and cannot be billed same day as a psychiatric or psychotherapy code. If the MedFT is treating a patient with both a mental health diagnosis and a physical health diagnosis, be clear which condition is addressed, and therefore, billed.

  • Each code (including the assessment) is based on 15 minutes of service. Bill two unites of service if the service is 30 minutes. Round to the nearest increment. If the service is 35 minutes, bill 2 units; if it is 40 minutes, bill 3 units.



Screening, Brief Intervention, and Referral to Treatment (SBIRT)

  • To address alcohol and/or substance prevention, use/abuse- NOT tobacco use.

  • Screening- use a standardized screening tool (e.g., AUDIT, DAST) to assess risky substance use.

  • Brief Intervention- review risky substance use behaviors with patient, provide advice, feedback (e.g., CBT, MI).

  • Referral to Treatment- provide an appropriate substance use referral (e.g., brief therapy vs. specialized treatment)

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Smoking Cessation

  • Tobacco cessation counseling for adolescents, adults, and pregnant women.

  • Patient must use tobacco, regardless of whether they have an illness related to tobacco use.

  • Must last at least 3 minutes

  • Documentation can include:

    • Impact of smoking and that you advised patient to quit

    • Current and historical tobacco use

    • Assessment of patient’s readiness to quit

    • Methods/skills to quit

    • Resources

    • Quit date

    • Follow-up

    • Amount of time spent counseling

  • Check with the patient’s insurance to see how many attempts they will bill annually

    • Ex: Medicare covers 2 attempts in a 12 month period with up to 8 counseling sessions annually (four billings of 99406 and four of 99407)


Psychiatric Collaborative Care Model (CoCM)

  • Behavioral health integration model that includes care management support for patients receiving behavioral health treatment and psychiatric consultation to the primary care team.

  • Care team members include:

    • Treating (billing) medical provider- physician, PA, NP, CNS, CNM.

    • Behavioral health care manager- someone with specialized training in behavioral health that works under the oversight of the billing provider. This person does not need to be licensed and can be trained in a range of disciplines including social work, nursing, psychology, family therapy.

    • Psychiatric consultant: medical professional trained in psychiatry and able to prescribe psychiatric medications.

    • Beneficiary- the patient.

  • Service Components:

    • Initial assessment.

    • Care plan creation with primary care team and patient. Revise care plan as needed for patients without sufficient improvement.

    • Behavioral health care manager duties include regular, proactive follow up:

      • Use validated rating scales, keep a registry of all patients enrolled in program

      • May provide evidence-based interventions such as motivational interviewing/behavioral activation

      • 70 min for 1st month

      • 60 min subsequent months

      • Add codes for additional 30 min

    • Psychiatric consultant: regular case load review. At minimum, primary care team meets weekly to discuss patient treatment plan and progress with consultant. Consultant offers recommendations.

Codes:

99492: Behavioral health care manager time: 70 min per calendar month

99493: Behavioral health care manger time: 60 minutes per subsequent calendar month

99494: Behavioral health care manager time: each additional 30 min per calendar month

Behavioral Health Care Management

  • Similar to CoCM but does not require a psychiatric consultant or behavioral health care manager.

  • Open for billing a variety of behavioral health integration models that include:

    • Initial assessment: initial visit and validated rating scales.

    • Systematic assessment and monitoring using applicable rating scales.

    • Care plan revision for patients with inadequate progress.

    • Facilitation and coordination of behavioral health treatment.

    • Continuous relationship with a designated care team member

Codes:

99484: Behavioral health care manager or clinic staff time: 20 min/calendar month


Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

  • There are specific considerations for FQHCs and RHCs. As of 2018, CMS has allowed these types of organizations to bill BHI, CCM, and CoCM using two new codes.

Codes:

G0511: General Care Management Services (minimum 20 min/calendar month), Can be billing for BHI and CCM services previously billed as 99490 or 99487

G0512: Psychiatric Collaborative Care Model Services, Minimum 70 min for the initial month and 60 minutes for subsequent months