CPT 99484: general behavioral health integration billing

Behavioral health integration, or BHI, connects behavioral health care with the patient’s other care. For Medicare general BHI, CPT 99484 requires at least 20 minutes of directed clinical staff time per calendar month and a defined set of service elements.

The code is not established by logging a check-in call alone. Your practice needs to understand the patient’s behavioral health needs, the continuing care plan, the work performed and which BHI model the team actually delivers.

Behavioral health integration meaning and patient eligibility

CMS describes eligible patients as having an identified mental, behavioral or psychiatric health condition, including substance use disorder, that requires assessment, care planning and interventions. The condition may already be known, or the billing practitioner may diagnose and refine it over time.

Other chronic or medical conditions may coexist, but they are not BHI eligibility requirements. Do not import CCM’s two-condition eligibility test into a behavioral health service.

For intake, identify the behavioral health need that the team will address and the practitioner responsible for directing care. A broad outreach list or an existing primary care relationship alone does not demonstrate the monthly service.

The mental health CPT codes guide provides the broader coding context. This page focuses on the general BHI care-management model and the work behind its monthly code, rather than psychotherapy or a catalogue of unrelated services.

Behavioral health integration codes: general BHI versus CoCM

Medicare distinguishes general BHI from the psychiatric collaborative care model, or CoCM. A psychiatric consultant and behavioral health care manager are optional for general BHI, while the CoCM model requires those roles alongside the treating practitioner.

Feature	General BHI	Psychiatric CoCM
Main code pathway	99484	99492 initial month; 99493 subsequent months
Time in the listed base code	At least 20 clinical-staff minutes per calendar month	70 care-manager minutes initial month; 60 subsequent month
Psychiatric consultant	Optional	Required
Behavioral health care manager	Optional designated role	Required designated role with behavioral health education or training
Continuing work	Assessment, care planning, coordination and continuity	Structured collaborative care with psychiatric consultation and registry-based follow-up

The presence of a psychiatric consultant does not automatically turn general BHI into CoCM. CMS expressly allows that professional to participate in general BHI; review the full model and service requirements, rather than using one team member as the deciding factor.

The 99492 collaborative care guide explains the initial CoCM month. General BHI codes cannot be reported in the same month as psychiatric CoCM codes for the same patient, although the appropriate model may change over several months.

For practices furnishing APCM, CMS introduced optional behavioral health add-on codes in 2026. The APCM behavioral add-on guide covers that separate pathway, including the required same-month APCM base service.

Establish the practitioner relationship and consent

Begin with the initiating visit

For new patients or patients not seen within the previous year, CMS requires an initiating visit with the billing practitioner before BHI begins. Qualifying visits include an annual wellness visit, initial preventive physical examination, comprehensive evaluation and management visit, or TCM face-to-face visit.

The practitioner must discuss BHI during the qualifying visit. A visit without that discussion does not count as initiation, even when its code appears on the qualifying list.

Document the patient’s permission before starting

Before BHI starts, the patient gives the billing practitioner permission to consult relevant specialists, including a psychiatric consultant. The practitioner must explain that cost sharing applies to face-to-face and non-face-to-face services even when supplemental insurance covers it.

CMS permits verbal consent when it is documented in the medical record. New consent is required when the patient changes billing practitioners, so a transfer should trigger a consent check instead of an assumption that the previous office’s record is sufficient.

Identify qualified roles and supervision

Physicians and non-physician practitioners whose scope includes evaluation and management services may bill BHI under CMS’s rules. Directed care-team services remain subject to applicable state law, licensure, scope and incident-to requirements.

General supervision means overall direction and control without requiring the practitioner’s physical presence during the service. It does not, by itself, create the qualifying relationship between the practitioner and care-team members.

How CPT 99484 works month to month

Assess or monitor the behavioral health condition

99484 requires an initial assessment or follow-up monitoring, including applicable validated rating scales. The record should show the behavioral health issue being followed and the assessment or monitoring actually performed.

A useful workflow connects the monitoring information to the practitioner’s care decisions. Repeating a score without showing the related care-management work leaves the team with an incomplete picture of the service.

Manage and revise the behavioral care plan

Behavioral health care planning includes revising treatment when the patient is not progressing or their status changes. Keep the current plan and its updates available to the team instead of relying only on a series of disconnected call notes.

Coordinate treatment and maintain continuity

The required service includes facilitating and coordinating treatment such as psychotherapy, medication treatment, counseling or psychiatric consultation. CMS also requires continuity with an appointed care-team member.

These are coordinated care-management activities, not a statement that every staff member can independently diagnose, prescribe or provide psychotherapy. Assign work according to each person’s qualifications and the practitioner’s direction.

Review qualifying time and completed services

The descriptor specifies at least 20 minutes of clinical staff time per calendar month. Administrative and clerical staff time does not count toward the BHI threshold; a time total must represent the qualifying clinical work.

CMS says the billing practitioner may deliver general BHI services in their entirety. Do not assume a commercial staff-time summary forbids that arrangement; verify the applicable coding and documentation for the services the practice actually furnishes.

Review the monthly record before selecting a code

A practical internal review brings the clinical work and time evidence together. This sequence organizes the CMS elements; it is not a CMS-prescribed form and does not replace individual claim review.

1. Confirm the identified behavioral health need and directing practitioner.
2. Locate the initiating-visit and documented consent evidence.
3. Review assessment or monitoring and the current behavioral health care plan.
4. Confirm treatment coordination and continuity with the appointed team member.
5. Check qualifying monthly time, staff roles and the selected care model.
6. Review other reported services for incompatible codes or duplicated work.

Describe who performed the work and what they did so the record can support the time total. An entry that says care management completed gives the reviewer less useful evidence than a description of the assessment, coordination or planning activity.

If the team changes care models, reconcile the new model with the services and codes for that month. Confirm an uncertain coding combination with the MAC instead of relying on a general online prohibition list.

Where BHI sits beside chronic care management

CMS permits CCM and BHI during the same service period when both sets of requirements and advance consent are met and time and effort are not counted twice. Cost sharing and consent apply to each service independently.

CCM addresses patients with two or more qualifying chronic conditions expected to last at least 12 months or until death and associated significant risk. BHI instead centers on the identified behavioral health need and its assessment, planning and interventions.

Keep the services identifiable in the record rather than reusing one undifferentiated activity log as evidence for both. The practice should verify applicable time and coding rules for the work actually performed.

CMS’s 2026 clarification about marriage and family therapists and mental health counselors concerns CHI and PIN: they may bill those services directly only for work they personally perform to diagnose or treat mental illness. It is a separate rule, not a replacement for the BHI code requirements.

Companian does not offer behavioral health integration or psychiatric collaborative care. These models are explained here as CMS programs so practices can distinguish them from ongoing chronic care services.

Evaluate ongoing chronic care separately

For eligible patients needing chronic care management services, review the CCM 99490/99439 pathway against its own requirements. Principal care management uses 99426/99427 for directed clinical-staff care focused on one qualifying high-risk condition.

Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”

Key takeaways

• General BHI connects behavioral health care with the patient’s other care.
• 99484 combines a monthly time threshold with required clinical service elements.
• A psychiatric consultant is optional for general BHI and required for CoCM.
• Document advance consent and the explanation of cost sharing.
• CMS permits CCM alongside BHI while retaining separate consent processes.

Frequently asked questions about behavioral health integration

What does BHI mean in Medicare care management?

BHI means behavioral health integration: connecting behavioral health care with other care, including primary care. Medicare distinguishes general BHI from the psychiatric collaborative care model.

Does general BHI require a psychiatric consultant?

No, CMS makes that role optional for general BHI. The consultant is a required part of the psychiatric CoCM team.

Does a patient need two chronic conditions for 99484?

BHI eligibility focuses on an identified behavioral health condition requiring assessment, planning and interventions. Other chronic medical conditions may coexist but are not BHI eligibility requirements.

Can documented verbal consent be used for BHI?

CMS permits verbal consent documented in the medical record. The patient must receive the required explanation before services begin, including that cost sharing applies.

Can general BHI and CoCM codes be reported for the same patient in one month?

CMS says general BHI codes cannot be reported in the same month as psychiatric CoCM codes for that patient. The appropriate model may change across different months.

Does meeting twenty minutes alone establish general BHI?

No, the time threshold accompanies assessment or monitoring, care planning, treatment coordination and continuity. The record must support the service elements as well as the qualifying time.

Medicare Part B behavioral health integration includes general BHI CPT 99484 and psychiatric CoCM codes 99492/99493/99494 for physician practices; Companian does not offer BHI or CoCM. Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”

Read more: Mental health coding context · Initial collaborative care month

Rates & disclosures

National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing. Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.

This guide summarizes CMS rules for practices nationwide and is not legal or billing advice.