Description: Care Management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by physician or qualified health care professional time
Delivery Method: Face-to-face, telephone or video
| Provider Location | Service | Code | Billing Allowances | Minimum Time Threshold | Payable Groups - Requirements | |||
|---|---|---|---|---|---|---|---|---|
| Commercial (BCBSM, BCN, Priority Health, HAP) |
Medicare | Medicare Advantage |
Medicaid | |||||
| Non FQHC/RHC | General Behavioral Health Integration | 99484 | Per calendar month | 11-20 minutes | ||||
| FQHC/RHC | Chronic Care Management/ General Behavioral Health |
G0511 | Per calendar month | 20 minutes | Cost share applies | Not Billable | ||
Billing opportunities and reimbursement may vary depending upon organization's specific payer value-based contracts. All services should be billed in accordance with CPT and Center for Medicare & Medicaid service guidelines.
MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors.
Recommended EMR Documentation: (Templates available here)
- Behavioral Health Care manager responsible for overall care plan, his/her credentials, and patient’s provider and contact information
- Patient Consent
- Date, duration, and modality of contact (face-to-face or video)
- Name and relationship of person contacted if other than patient
- Assessment, treatment plan – including evidence-based interventions
- Referrals if appropriate
- Medication Management
Activities Include:
- Advanced Consent:
- Verbal or written, must be documented in the EHR
- Permission to consult with relevant specialists (i.e., psychiatric consultant)
- Inform the patient of cost sharing
- Time spent completing initial assessment and follow-up
- Establishing behavioral health care plan
- Coordinating treatment options, and continuity of care with designed care-team member