Last Modified: 5/15/2024
Location: FL, PR, USVI
Business: Part B
Medicare pays for behavioral health services that may improve outcomes for Medicare patients. They include:
• Behavioral Health Integration (BHI) Services
• Psychotherapy for Crisis
• Opioid Use Disorder (OUD) Screening & Treatment
BHI is a model of care incorporating behavioral health care into other care, like primary care, to improve mental, behavioral, or psychiatric health for many patients. These BHI services may be particularly helpful for patients who aren’t improving under other models of care.
In addition to payment for evaluation and management (E/M) services, Medicare covers two types of BHI services:
• Psychiatric Collaborative Care Model (CoCM):
• A team of three individuals delivers CoCM:
• Behavioral health care manager
• Psychiatric consultant
• Treating (billing) practitioner
• This model enhances primary care by adding two key services to the primary care team:
• Care management support for patients getting behavioral health treatment
• Regular psychiatric inter-specialty consultation
• To bill for psychiatric CoCM services use CPT codes 99492, 99493, 99494 and HCPCS code G2214. Payment is for services supplied over a calendar month.
• General BHI services using models of care other than CoCM:
• To bill, use CPT code 99484 and HCPCS code G0323 to account for monthly care integration.
• General BHI includes service elements like:
• Systemic assessment and monitoring
• Care plan revision for patients whose condition isn’t improving adequately
• Continuous relationship with an appointed care team member
Code Descriptor
99492 Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities
99493 Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities
99494 Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities (Add-on for CoCM, any month)
G2214 Initial or subsequent psychiatric collaborative care management
99484 Care management services for behavioral health conditions at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
G0323 Care management services for behavioral health conditions at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month
References:
Psychotherapy for crisis services is appropriate for patients in high distress with life-threatening, complex problems requiring immediate attention. These services can help reduce a patient’s mental health crisis (including substance use disorder [SUD]) through:
• Urgent assessment and history of a crisis state
• Mental status exam
• Disposition (or what happens next for the patient)
Physicians and non-physician practitioners whose scope of covered Medicare services includes diagnosis and treatment of mental illnesses can offer these services. This includes clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, and certified nurse midwives. Medicare pays for these services under the Physician Fee Schedule.
CMS issued the
CY 2024 Physician Fee Schedule (PFS) proposed rule 
announcing proposed policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. This rule includes increased payment for
Psychotherapy for crisis equal to 150% of the fee schedule amount for services furnished in non-facility sites of service, other than a physician or practitioner’s office. This information is outlined in the Consolidated Appropriations Act (CAA), 2023 and is effective January 1, 2024.
Code Descriptor
90839 Psychotherapy for crisis; first 60 minutes
90840 Each additional 30 minutes, Use in conjunction with 90839
Note: Psychotherapy for crisis codes cannot be reported with 90791, 90792, 90785-90899 and 90832-90838.
References:
• LCD
L33252 -- Psychiatric diagnostic evaluation and psychotherapy services
• LCA
A57520 -- Billing and Coding: Psychiatric diagnostic evaluation and psychotherapy services
Medicare pays OUD screenings performed by physicians and non-physician practitioners. These services include:
• Screening for OUD is a required element of Medicare’s Initial Preventive Physical Exam (HCPCS G0402) and Annual Wellness Visits (HCPCS G0438 and G0439).
• During visits in physicians’ offices and outpatient hospital settings:
• Medicare will pay for Screening, Brief Intervention & Referral to Treatment (SBIRT):
• SBIRT is an evidence-based, early intervention approach for people with non-dependent substance use before they need more specialized treatment.
Code Descriptor
G2011 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 5-14 minutes
G0396 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
G0397 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
If a patient is diagnosed with OUD, Medicare pays for certain treatment services, including:
• E/M visits for medication management:
• Use CPT codes 99202-99499 to represent visits and services involving evaluating and managing patient health.
• Use E/M visits to provide medication management to ensure patients take medications (like buprenorphine) properly as part of their recovery process:
• E/M service must be reasonable and necessary and meet the E/M criteria.
• Office-based SUD treatment services offer a way to bill for a group of services for the treatment of SUDs in the office setting.
• Office-based SUD treatment services include:
• Overall management
• Care coordination
• Individual and group psychotherapy
• Substance use counseling
• Add-on code for additional counseling
• Medicare pays for a monthly bundle of services (for patient prescribed buprenorphine or naltrexone in the office setting) for the treatment of OUD or other SUDs.
Code Descriptor
G2086 Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month
G2087 Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month
G2088 Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)
Reference:
OTPs provide medications for opioid use disorder (MOUD), including methadone, buprenorphine, and naltrexone, as well as a range of other services including individual and group therapy, substance use counseling, and toxicology testing, for patients diagnosed with OUD.
Payments are made to the OTP through a bundled payment for OUD treatment services. Under the OTP benefit Medicare covers:
• U.S. FDA-approved opioid agonist and antagonist medication assisted treatment (MAT) medications
• Dispensing and administering MAT medications, if applicable
• Substance use counseling
• Individual and group therapy
• Toxicology testing
• Intake activities
• Periodic assessments
Code Descriptor
G2067 Medication assisted treatment, methadone
G2068 Medication assisted treatment, buprenorphine (oral)
G2069 Medication assisted treatment, buprenorphine (injectable)
G2070 Medication assisted treatment, buprenorphine (implant insertion)
G2071 Medication assisted treatment, buprenorphine (implant removal)
G2072 Medication assisted treatment, buprenorphine (implant insertion and removal)
G2073 Medication assisted treatment, naltrexone
G2075 Medication assisted treatment, medication not otherwise specified
Code Descriptor
G2074 Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)
Code Descriptor
G2076 Intake activities
G2077 Periodic assessment
G2078 Take-home supply of methadone
G2079 Take-home supply of buprenorphine (oral)
G2080 Each additional 30 minutes of counseling in a week of medication assisted treatment
G2215 Take-home supply of nasal naloxone
G2216 Take-home supply of injectable naloxone
G1028 Take-home supply of nasal naloxone
Code Descriptor
G0137 Intensive outpatient program services
References:
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