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 | ||
All services should be billed in accordance with CPT and Center for Medicare & Medicaid service guidelines.
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