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BHI enables primary care practices to formally address behavioral health conditions within the care team. Medicare reimburses monthly for the care manager time and psychiatric consultation required to support patients with depression, anxiety, and other behavioral health conditions.
Behavioral Health Integration is a structured program that allows primary care practices to formally bill Medicare for the time their care team spends addressing behavioral health conditions. The program requires a designated care manager, an overseeing billing provider, and access to a psychiatric consultant who reviews cases and advises on treatment.
BHI recognizes that most behavioral health needs are managed in primary care settings rather than specialty mental health settings. By creating formal billing pathways, Medicare incentivizes practices to systematically screen, track, and treat patients with conditions like depression and anxiety.
Two models available: General BHI (99484) is simpler and requires only 20 minutes of care manager time per month. The Collaborative Care Model (CoCM, using 99492/99493) is more intensive but reimburses at a higher level and supports more complex patients.
| Code | Description | Requirement |
|---|---|---|
| 99484 | General BHI: Care Manager Activities Psychiatrist or clinical psychologist serves as consultant | 20 min/month |
| 99492 | Initial PBHCI - First month Psychiatric Collaborative Care Model, first calendar month | 70 min |
| 99493 | Subsequent PBHCI - Each subsequent month Psychiatric Collaborative Care Model, ongoing | 60 min |
| 99494 | Add-on - Additional 30 minutes Can be billed with 99492 or 99493 | 30 min |
We identify patients with qualifying behavioral health diagnoses or elevated screening scores (PHQ-9, GAD-7) from EHR data.
Patients are enrolled with documented consent and an initial behavioral health assessment.
Dedicated care managers conduct regular check-ins, administer validated screening tools, and track patient progress on a registry.
A psychiatric consultant reviews cases on a scheduled basis, advises on treatment adjustments, and documents recommendations.
Every care manager and consultant interaction is documented with time, ensuring monthly thresholds are met before billing.
Claims are generated after compliance validation and submitted under the appropriate CPT code for each patient.
General BHI uses CPT 99484, requiring 20 minutes of care manager time per month. The Psychiatric Collaborative Care Model (CoCM) uses CPT 99492 (first month, 70 minutes), 99493 (subsequent months, 60 minutes), and the 99494 add-on for an additional 30 minutes.
Depression (PHQ-9 score of 5 or higher), generalized anxiety disorder (GAD-7 score of 5 or higher), PTSD, bipolar disorder, alcohol and substance use disorders, eating disorders, and ADHD.
A designated care manager, an overseeing billing provider, and access to a psychiatric consultant who reviews cases on a scheduled basis and advises on treatment adjustments.
Yes. BHI can be billed in the same month as CCM or APCM for the same patient, which significantly increases per-patient monthly revenue.
Most primary care practices are already managing behavioral health informally. BHI creates a structured, billable framework so you can get paid for the work your team is already doing.
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