CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Behavioral Health Integration Services Payment Policy

Governs payment guidelines for primary care providers delivering integrated behavioral health services, including the Collaborative Care Model (CoCM), for Blue Cross Blue Shield of Rhode Island members across applicable products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Integration Services Payment Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJun 1, 2019

Next Review DateN/A

Key ActionProviders must submit a detailed program description and receive BCBSRI approval to bill CoCM or general BHI services separately.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4CoCM codes listed

20 min99484 minimum time

WeeklyCaseload review frequency

1Program submission required

Coverage Criteria for CoCM and BHI

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CoCM and general BHI services are covered but are not separately reimbursed unless the provider submits a detailed program description and receives BCBSRI approval.

ALL of the following

Job description for the behavioral health care manager showing collaborative integrated relationship with team members and formalized training or specialized education in behavioral health (e.g., social work, nursing, or psychology).
Initial assessment including administration of validated scales and a resulting treatment plan.
Plan for identification, outreach and engagement of patients directed by a primary care provider.
Evidence of a compact/contract with a psychiatric consultant.
Psychiatric consultation and referral process.
Written workflows documenting evidence-based treatment interventions, relapse prevention planning and discharge preparation, plans for ongoing collaboration and coordination with PCP and other treating providers, use of a registry for tracking follow-up and progress, monitoring outcomes with validated rating scales, and weekly caseload review with the psychiatric consultant.

ALL of the following

Initial assessment.
Systematic assessment and monitoring using applicable validated clinical rating scales.
Facilitation and coordination of behavioral health treatment.
Care planning by the primary care team jointly with the beneficiary, with care plan revision for patients whose condition is not improving.
Continuous relationship with a designated member of the care team.

Optional/supporting program elements (may be included to strengthen the program description):

Employ or contract with a dedicated behavioral health care manager (not required to be independently licensed but must have relevant behavioral health experience).
Maintain a registry for behavioral health conditions (at minimum: depression, anxiety, substance use disorders).
Facilitate and coordinate psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation.
Provide brief psychosocial interventions, coaching and support.
Identify a BH care manager as the designated contact for BH care management needs.
Demonstrate ongoing collaboration with the practitioner billing and capability to report on measures (e.g., depression remission/response, follow-up care for children on ADHD meds, unhealthy alcohol use screening/brief counseling).

ALL of the following

Specific CPT/G codes (99492, 99493, 99494, G0512 for RHC/FQHC, and 99484 for general BHI) are recognized but are covered and not separately reimbursed except for providers who have submitted a program description and received BCBSRI approval.
G0512 applies only to RHC/FQHC for 60 or more minutes of clinical staff time per month.
Program descriptions must include provider/billing information and NPI(s) on the cover sheet when submitted to Behavioralhealth@bcbsri.org.

ALL of the following

Prior authorization is not applicable for these services per policy.

ALL of the following

Benefits may vary among groups; refer to the applicable Benefit Booklet or Evidence of Coverage for member-specific determinations.

Billing Codes and Coding Rules

Collaborative Care Management CodesCPTCovered

99492	Initial psychiatric collaborative care management; first 70 minutes in the first calendar month
99493	Subsequent psychiatric collaborative care management; first 60 minutes in subsequent month
99494	Each additional 30 minutes in calendar month (add-on)
G0512	RHC/FQHC only, psychiatric CoCM, 60 minutes or more per calendar month

General Behavioral Health Integration CodeCPTCovered

99484

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time per calendar month

inv-04: Separate reimbursement eligibility

Separate reimbursement policyCoCM and general BHI codes are covered but are not separately reimbursed unless the provider submits a detailed program description and receives BCBSRI approval.

Submission requirementProgram descriptions must be submitted to Behavioralhealth@bcbsri.org and include provider/billing information and National Provider Identifier(s).

Program description contents (CoCM)Must include BH care manager job description, initial assessment with validated scales and treatment plan, plan for patient identification/outreach, compact/contract with psychiatric consultant, psychiatric consultation/referral process, written workflows (evidence-based interventions, relapse prevention, care coordination), registry use, outcome monitoring, and weekly caseload review with psychiatric consultant.

Program description contents (general BHI)Must indicate meeting required elements: initial assessment; systematic assessment/monitoring with validated scales; facilitation/coordination of behavioral health treatment; joint care planning with beneficiary; continuous relationship with designated care team member; optional supportive elements (dedicated BH care manager, registry, reporting capability, face-to-face and telephonic services).

inv-05: Time thresholds

99492Initial psychiatric collaborative care management: first 70 minutes in the first calendar month of behavioral health care manager activities.

99493Subsequent psychiatric collaborative care management: first 60 minutes in a subsequent calendar month of behavioral health care manager activities.

99494Each additional 30 minutes in a calendar month of behavioral health care manager activities (add-on to primary CoCM codes).

99484Care management services for behavioral health conditions: at least 20 minutes of clinical staff time per calendar month with required elements (assessment, monitoring with validated scales, care planning, coordination, continuity).

Provider Submission & Billing Actions

Prior Authorization

Prior Authorization: Not applicable. No prior authorization is required for these services.

Documentation Required

Collaborative Care Management (CoCM) — Program Approval Required

Program approval required for separate reimbursement of Collaborative Care Management (CoCM). CoCM services are covered but not separately reimbursed unless the provider submits a program description and receives BCBSRI approval. Program descriptions must include job description for the behavioral health care manager, initial assessment with validated scales and treatment plan, patient identification/outreach plan directed by the PCP, evidence of a contract with a psychiatric consultant, psychiatric consultation/referral process, written workflows documenting evidence‑based treatment interventions, relapse prevention and discharge planning, plans for ongoing collaboration with PCP and other providers, demonstrated use of a registry for tracking follow‑up and progress, evidence of monitoring outcomes with validated rating scales, and evidence of weekly caseload review with the psychiatric consultant.

Program descriptions must include: job description for behavioral health care manager; initial assessment with validated scales and treatment plan; patient identification/outreach plan; contract with psychiatric consultant; psychiatric consultation/referral process; written workflows for evidence‑based interventions; relapse prevention/discharge planning; plans for ongoing collaboration with PCP/other providers; use of a registry for tracking follow‑up and progress; monitoring of outcomes with validated scales; weekly caseload review with psychiatric consultant.

Documentation Required

General Behavioral Health Integration — Program Description & Submission Required

Program description required for separate reimbursement of general Behavioral Health Integration (BHI) models. Care management for behavioral health conditions is covered but not separately reimbursed unless the practice submits a detailed program description and receives BCBSRI approval. The submission must demonstrate required elements: initial assessment; systematic assessment and monitoring using validated clinical rating scales; facilitation and coordination of behavioral health treatment; joint care planning with the beneficiary and revisions if not improving; and a continuous relationship with a designated member of the care team. Supporting elements that should be included when applicable: employment/contract of a dedicated BH care manager with relevant behavioral health experience, maintenance of a registry for behavioral health conditions (minimum: depression, anxiety, substance use), facilitation of psychotherapy/pharmacotherapy/psychiatric consultation, brief psychosocial interventions, designation of BH care manager contact, demonstration of ongoing collaboration with the billing practitioner, capability to report specified measures on request, ability to provide face‑to‑face and telephonic services during and outside clinic hours, and alignment with OHIC measures (depression remission/response, ADHD follow‑up, unhealthy alcohol screening/brief counseling). All program descriptions must be sent to Behavioralhealth@bcbsri.org and include a cover sheet with provider billing numbers, provider information, and NPI.

Required elements: initial assessment; systematic assessment/monitoring with validated scales; facilitation/coordination of behavioral health treatment; joint care planning with beneficiary and plan revision if not improving; continuous relationship with designated care team member.
Supporting elements (recommended): dedicated BH care manager with behavioral health experience; registry for behavioral health conditions (depression, anxiety, substance use); coordination of psychotherapy/pharmacotherapy/psychiatric consultation; brief psychosocial interventions; designated BH care manager contact; ongoing collaboration with billing practitioner; ability to report measures on request; face‑to‑face and telephonic service capability; OHIC‑aligned measures reporting.

Key Definitions

inv-09: CoCM

DefinitionThe Collaborative Care Model (CoCM) is a team-based approach to behavioral health integration involving a primary care practitioner, a behavioral health care manager, and a psychiatric consultant; BCBSRI follows CMS CoCM guidelines.

Team rolesPrimary care practitioner provides overall treatment; behavioral health care manager delivers assessment, monitoring, registry use, and care coordination; psychiatric consultant provides case review and guidance.

Program expectationsPrograms should document a compact/contract with a psychiatric consultant, weekly caseload review with the consultant, and use of validated outcome scales as part of CoCM services.

inv-10: BHI care management

DefinitionBehavioral Health Integration (BHI) care management are care management services for behavioral health conditions provided by clinical staff, directed by a physician or other qualified health care professional, including assessment, monitoring with validated scales, care planning, coordination and continuity with a designated care team member.

Service deliveryGeneral BHI care management is provided face-to-face by clinical staff under the direct supervision of a physician or qualified health professional; programs may also provide telephonic services.

Required elementsIncludes initial assessment, systematic assessment/monitoring using validated scales, facilitation/coordination of treatment, joint care planning with beneficiary, and continuous relationship with a designated care team member.