Behavioral Health Integration Billing (CPT 99484)
Revenue Opportunity: $48+/patient/mo
Per eligible patient based on national Medicare rates
Behavioral Health Integration (BHI) is the fastest-growing opportunity in Medicare care management. As mental health awareness increases and CMS expands coverage for integrated behavioral health services, practices that implement BHI are capturing significant new revenue while addressing a critical gap in patient care.
CPT 99484 allows primary care and specialty practices to bill for behavioral health care management — even without an in-house psychiatrist. This guide explains the BHI model, billing requirements, and how to build a BHI program that generates sustainable revenue.
What Is Behavioral Health Integration?
BHI is a CMS program that reimburses for care management services provided to patients with behavioral health conditions (depression, anxiety, substance use disorders, etc.) when those conditions are managed in a primary care or specialist setting rather than referred out to mental health providers.
The program recognizes that many patients with behavioral health conditions receive their mental health care — or should receive it — from their primary care provider. BHI creates a billing mechanism for the coordination and management work that was previously uncompensated.
BHI CPT Codes and Reimbursement
BHI billing uses several codes, depending on the care model implemented.
- 99484 — General BHI: 20+ minutes per month of clinical staff time for behavioral health care management. Reimbursement: ~$49/month
- 99492 — Psychiatric Collaborative Care Model (CoCM): initial 70+ minutes in the first month. Reimbursement: ~$164/month
- 99493 — Subsequent CoCM: 60+ minutes per month. Reimbursement: ~$130/month
- 99494 — Additional 30 minutes of CoCM in the same month. Reimbursement: ~$67
💡 Pro Tip: 99484 (General BHI) is the easiest code to implement because it doesn't require a consulting psychiatrist. It's the best starting point for most practices. CoCM codes (99492-99494) pay more but require a formal collaborative care team including a behavioral health care manager and a psychiatric consultant.
Patient Eligibility for BHI
BHI eligibility is straightforward. Patients must have a diagnosed behavioral health condition that requires ongoing care management.
- Diagnosed behavioral health condition: depression, anxiety, PTSD, bipolar disorder, substance use disorder, ADHD, eating disorders, etc.
- Condition is being actively treated or managed by the billing provider
- Patient consent must be obtained and documented
- Only one provider can bill BHI per patient per month
- Patient does NOT need to have other chronic conditions (unlike CCM)
Common PitfallBHI and CCM can technically be billed for the same patient, but the time used for BHI activities cannot double-count toward CCM time. Keep separate time logs for each program.
Qualifying Activities for 99484
To bill 99484, clinical staff must spend at least 20 minutes per month on behavioral health care management activities. These activities must be directly related to the patient's behavioral health condition.
- Systematic assessment using validated tools (PHQ-9 for depression, GAD-7 for anxiety)
- Care plan development and revision for behavioral health conditions
- Patient outreach and engagement (phone calls, portal messages about mental health)
- Medication monitoring and side effect assessment
- Coordination with therapists, social workers, or psychiatrists
- Crisis intervention planning and safety assessments
- Facilitating referrals to community behavioral health resources
Screening: The Gateway to BHI Revenue
Universal behavioral health screening is the key to identifying BHI-eligible patients at scale. Implementing the PHQ-2/PHQ-9 for depression and GAD-7 for anxiety as standard intake questionnaires ensures you're catching patients who qualify.
In a typical primary care panel, 20-30% of patients screen positive for depression or anxiety. Many of these patients are already being managed informally — BHI simply creates a billing structure for that work. Start by screening all Medicare patients at every annual wellness visit and problem-focused visits.
Building a BHI Program
Start with 99484 (General BHI) since it has the lowest implementation barrier. Identify a care coordinator (RN, LCSW, or trained MA) to manage your BHI patient panel. This person conducts monthly outreach, administers screening tools, updates care plans, and coordinates with the supervising provider.
Establish a workflow where positive screens trigger automatic BHI enrollment conversations. Create standardized care plan templates in your EHR for common conditions. Track time meticulously using the same tools you'd use for CCM. Review population health metrics monthly to measure outcomes.
💡 Pro Tip: BHI pairs exceptionally well with CCM. Many patients with chronic conditions also have depression or anxiety. A patient enrolled in both CCM and BHI can generate $115+ per month — just ensure time is tracked separately for each program.
The Collaborative Care Model (CoCM) — Advanced
Once your BHI program is established, consider upgrading to the Collaborative Care Model for higher reimbursement. CoCM requires three team members: the billing provider (PCP), a behavioral health care manager (LCSW, RN, or psychologist), and a consulting psychiatrist who reviews cases weekly.
CoCM pays significantly more ($130-164/month vs $49 for general BHI) but requires the psychiatric consultant relationship. Many practices contract with tele-psychiatry services to meet this requirement cost-effectively.
Key Takeaways
- 1.99484 (General BHI) pays ~$49/month for 20+ minutes of behavioral health care management
- 2.No consulting psychiatrist needed for 99484 — making it easy to implement
- 3.Universal PHQ-9/GAD-7 screening identifies eligible patients at scale
- 4.20-30% of primary care Medicare patients screen positive for depression or anxiety
- 5.BHI can be combined with CCM for the same patient (track time separately)
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