Integrating behavioral health into primary care settings is seen as a pathway for widening patient access to services. But physician and staff shortages require creativity to make it happen. There is also a need to test, pay for and measure the effectiveness of these innovations, and the Current Procedural Terminology (CPT®) code set provides a foundation to do so.
“The AMA is empowering physicians and their care teams to improve the quality and care, and expand patients’ timely access to equitable care through behavioral health integration, which involves bringing medical and behavioral health services together within primary and other specialty care settings,” said Zach Hochstetler, MPP, the AMA’s vice president of coding and payment.
“This helps improve access to behavioral health screening and coordinated treatment, promotes whole person health and reduces the risk of self-harm and suicide,” he added.
Hochstetler moderated a webinar discussion on how CPT codes can be used when administering behavioral health screening, treatment or preventive services while helping physicians and patients overcome barriers to care and succeed within high-value care arrangements.
The webinar, which is available on demand (registration required), showcased the AMA Behavioral Health Integration (BHI) Collaborative and a case study (PDF) of the work conducted by the virtual behavioral health medical group, Concert Health, that was done with the AMA’s Future of Health series.
The challenges physicians and patients face when addressing behavioral health conditions are the lingering consequence of the longstanding separation of behavioral and physical health in the U.S. health care system. These challenges are exacerbated by differences in coverage and payment that persists despite the passage of laws to ensure mental and physical health parity.
This led to the AMA establishing the BHI Collaborative and creating the BHI webinar series, a collection of in-depth discussions that explores ways practices can sustain a collaborative, integrated, whole-person and equitable approach to physical and behavioral health care.
“They really focus on the practical aspects of workflow, information sharing, structuring, and how you actually provide that within the practice,” said Leslie Prellwitz, a certified coding specialist and the AMA’s director of CPT content management and development.
Prellwitz also noted that the mission of the AMA BHI Collaborative was to “catalyze effective and sustainable integration of behavioral and mental health care into physician practices,” and its vision was to “identify and manage mild to moderate behavioral health conditions as a core competency of physician practices—not an exception.”
Broad scope of services covered
CPT codes for behavioral health span the care continuum starting with preventive treatments such as behavior-change interventions, then screening and assessments, and progressing to treatment and care coordination services.
Prellwitz noted that the CPT codes have kept current and helped support behavioral health by covering remote therapeutic monitoring, which may include cognitive behavioral therapy.
“Traditionally, health care was delivered face to face in a brick-and-mortar building, but increasingly, we are working in a virtual world, in a digital world,” she said. “The great thing about CPT is that it is evolving along with that transformation.”
Prellwitz noted the care-management codes, which cover one month of service as opposed to most CPT codes, which cover a single patient encounter.
Or, in the case of CPT code 99483, cognitive assessment and care plan services, reporting is once every 180 days.
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CPT code set supports telemedicine
Behavioral health codes included on the Centers for Medicare & Medicaid Services list of covered services grew 31% between March 2020 and November 2023, going to 58 from 40.
Growth was seen in screening and assessment codes, going to 25 from 15, and treatment codes, going to 19 from 11.
“I would say for behavioral health and CPT, it continues to increase access through increased applicability in telemedicine environments,” Prellwitz said.
Virna Little, PsyD, is co-founder of Concert Health, and said her organization has been using telehealth since its inception in 2016—about the same time the CPT collaborative care codes were adopted.
“Collaborative care does not need to be in person—it can be virtual, telephonic, video or in person, you really have the option,” Little said. “Collaborative care was telephonic way before it was fashionable with COVID.”
Concert Health works with primary care practices to support behavioral health services, providing a “collaborative care clinician” in a care-management role and psychiatric consultant who communicates with the primary care physician (who Little refers to as “the captain of the ship”) over the phone but doesn’t see patients.
“This summer we're actually going to reach our 100,000th patient, which is very exciting because I think we're starting to now get a good database on how effective the model can be,” Little said. “We’re working out of 19 states and that number continues to grow.”
Concert Health uses evidence-based, standardized tools to measure depression, anxiety and pediatric attention-deficit/hyperactivity disorder and frequent, brief contacts with patients.
The primary CPT collaborative care code it uses is 99492 for the initial 70 minutes in a month. It covers activities such as updating patient registries, talking to the primary care physician and psychiatric consultation. Code 99493 covers subsequent activities for the first 60 minutes in a subsequent month, with 99494 reported for each additional 30 minutes for either code.
Little noted that these codes are included in the Medicaid physician pay schedule in 34 states and more are in the process of adding them.
“These codes … allow health care physicians to bill based on a monthly case rate tied to the time spent on CoCM [collaborative care model] related activities,” the Concert Health case study says. “By utilizing these codes, Concert Health helps physicians overcome barriers such as prior authorization, service limits, and specialty copays typically associated with the specialty of mental health care.”
