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What the CPT Code 99484 Reimbursement Means for Your Bottom Line

Much of the conversation about the Behavioral Health Integration services introduced by the Centers for Medicare & Medicaid Services (CMS) in 2018 focuses on collaborative care management. While this represents an important part of the CMS push to reimburse for providing integrated behavioral health, it may only apply to a small percentage of the Medicare beneficiaries that a primary care practice sees.

That’s why it’s important to understand the ins and outs of Current Procedural Terminology (CPT) code 99484 reimbursement, which covers care management for general BHI services. Practices that integrate behavioral health and primary care can provide valuable services to their patients in a familiar care setting – and generate additional revenue for the work they’re already doing, whether billing Medicare or commercial payers that reimburse for integrated behavioral health services.

Download the eBook The Guide to Behavioral Health Assessment Software:  Improving Assessments & Patient Outcomes here.

A Closer Look at CPT 99484 Billing Guidelines

The American Psychiatric Association defines CPT code 99484 as general care management services for patients with behavioral health conditions, which incorporate some but not all of the principles associated with collaborative care. The service can be billed monthly once you reach at least 20 minutes of clinical staff time.* 

CMS has further identified several core components of general BHI services that meet the criteria for CPT code 99484 reimbursement.

  • Initial assessment.

     This may include administering applicable validated clinical rating scales to assess a patient’s likelihood of a diagnosis of depression, anxiety, or other mental health conditions.
  • Systematic assessment and monitoring.

     This should include administering applicable validated clinical rating scales.
  • Joint care planning with the patient.

     The primary care practice should conduct this planning. CMS advises that revisions may be necessary for patients whose condition isn’t improving.
  • Facilitation and coordination of behavioral health treatment.

     This may include making referrals for psychotherapy, pharmacotherapy, counseling, or psychiatric consultations.
  • Continuous relationship with an appointed member of the care team.

     The patient should have a single point of contact for managing their behavioral health needs.

CMS has classified eligible conditions for general BHI services as:

“any mental, behavioral health, or psychiatric condition that the billing practitioner treats, including substance use disorders.”

The diagnosis could be pre-existing or made by the billing practitioner. Additionally, the billing practitioner may manage a patient’s chronic and/or comorbid medical conditions, though this isn’t required under CPT 99484 billing guidelines. 

In addition to the patient, the members of the general BHI care team are the billing practitioner and clinical staff. The billing practitioner is often a primary care physician or nurse practitioner, CMS notes; in some cases, though, it may be a practitioner in a specialty such as cardiology or oncology whom a patient also sees regularly and has an established “continuous relationship.” Meanwhile, clinical staff may include those who deliver behavioral health or psychiatric services. 

How the CPT 99484 Reimbursement Rate Can Drive Practice Revenue

Billing practitioners can bill general BHI services once per calendar month per patient. The CPT code 99484 average Medicare reimbursement rate for 2023 was $43.04 per encounter. This rate can add up. 

It’s worth noting CMS allows practitioners to bill for general BHI and chronic care management (CCM) services for the same patient in the same calendar month. As CMS says:

“The BHI codes can be billed for the same patient in the same month as CCM if advance consent for both services and all other requirements to report BHI and to report CCM are met and time and effort are not counted more than once.”

There are several billing codes for chronic care management. Those most likely to apply in this scenario are CPT code 99490 (the first 20 minutes of services provided in a calendar month to coordinate care and support patient accountability for patients with non-complex CCM) and CPT code 99439 (each additional 20 minutes per calendar month). According to sources, the CPT code 99490 reimbursement rate is $62.69, and the CPT code 99439 reimbursement rate is $47.44.

More Options for CMS Reimbursement for General BHI

A subset of CPT codes known as the Healthcare Common Procedure Coding System (HCPCS) codes offer additional options for qualified practitioners to offer integrated behavioral health services and generate revenue for their practices.  

One is HCPCS code G0323. CMS introduced this billing code in 2023 to cover services furnished by a clinical psychologist or clinical social worker, allowing primary care practices to expand the care teams supporting general BHI. Under this billing code, a designated behavioral healthcare manager is not required. Like CPT code 99484, HCPCS code G0323 covers 20 minutes of services per calendar month and reimburses at a rate of $43.04. 

Another is HCPCS code G0511. This billing code covers the same services and billing practitioners as both CPT code 99484 and HCPCS code G0323 but applies specifically to federally qualified health centers that operate in traditionally underserved areas. The reimbursement rate for HCPCS code G0511 is higher, at $77.94, as it’s meant to help FQHCs recoup the cost of providing integrated behavioral health services and implementing value-based care.  

The population of the United States continues to age, and patients increasingly seek help to manage their behavioral health and well-being. Amid these trends, primary care practices would be wise to consider CPT code 99484 reimbursement and other opportunities to be compensated for providing Medicare beneficiaries and other patients with general BHI services from practitioners they trust. To find out more about how the Proem workflow solution can support the delivery of BHI, book a meeting. 

* CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose.  No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with Proem and no endorsement by the AMA is intended or implied.

The Guide to Behavioral Health Assessment Software: Improving Assessments & Patient Outcomes

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