Behavioral health code set billing for Elevate Medicaid Choice
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Describes which behavioral health-related CPT/HCPCS code groups (HBAI, CoCM, E&M, BH E&M add-ons) Primary Care Medical Providers and behavioral health providers can bill to Elevate Medicaid Choice for reimbursement in Colorado.
No material clinical or coverage changes in this revision.
Behavioral Health Coverage Criteria
General coverage criteria for behavioral health codes
Covered when ALL of the following apply:
HBAI coverage
- Health Behavior Assessment and Intervention (HBAI) codes are covered when billed to Elevate Medicaid Choice per HCPF guidance; these codes focus on assessment and interventions addressing behavioral health factors in a medical setting.
CoCM coverage
- Collaborative Care Model (CoCM) codes are covered when billed to Elevate Medicaid Choice per HCPF guidance; these codes provide psychiatric care integrated into a primary care setting.
E&M coverage and requirements
- Evaluation & Management (E&M) codes listed are covered by Elevate Medicaid Choice under the medical benefit when the claim includes a behavioral health diagnosis and is billed by a behavioral health specialist.
- There are no visit limitations on the listed E&M codes.
- Providers should follow HCPF State Behavioral Health Services Billing Manual for additional billing guidance and exact code lists.
Examples of covered E&M code categories
- Hospital, subsequent, same-day admit/discharge, and discharge E&M codes (e.g., 99221–99223, 99231–99233, 99234–99236, 99238–99239).
- Nursing facility, residence visit, and team conference codes (e.g., 99304–99310, 99315–99316, 99341–99350, 99366–99368).
- Telephone and consultation/ED E&M codes listed (e.g., 99441–99443, 99242–99245, 99252–99255, 99281–99285).
Behavioral health E&M add-on codes
Some BH E&M services (including add-ons) may be reimbursed under behavioral health capitation when billed with an Evaluation & Management code covered under behavioral health capitation.
Provider billing permissions
- Effective 7/1/2025, Primary Care Medical Providers (PCMPs) may bill HBAI and CoCM codes to Elevate Medicaid Choice for reimbursement.
- E&M claims must include a behavioral health diagnosis (example: a behavioral health condition rather than an unrelated medical diagnosis) to be processed under Elevate Medicaid Choice behavioral health coverage.
References
- Consult HCPF fact sheets for HBAI and CoCM and the HCPF State Behavioral Health Services Billing Manual for full code lists and billing instructions.
Covered Codes and Documentation Thresholds
| 99202 | Office or other outpatient new patient visit, 15-29 minutes |
| 99203 | Office or other outpatient new patient visit, 30-44 minutes |
| 99204 | Office or other outpatient new patient visit, 45-59 minutes |
| 99205 | Office or other outpatient new patient visit, 60-74 minutes |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, typically 5 minutes |
| 99212 | Office or other outpatient established patient, 10-19 minutes |
| 99213 | Office or other outpatient established patient, 20-29 minutes |
| 99214 | Office or other outpatient established patient, 30-39 minutes |
| 99215 | Office or other outpatient established patient, 40-54 minutes |
| 99242 | Outpatient consultation, 20-29 minutes |
| 99221 | Initial hospital care, typically 30 minutes at bedside and on the patient's hospital floor (documented thresholds: 40+ minutes for behavioral health billing per source) |
| 99222 | Initial hospital care, typically 50 minutes (55+ minutes threshold noted) |
| 99223 | Initial hospital care, typically 70 minutes (75+ minutes threshold noted) |
| 99231 | Subsequent hospital care, typically 15 minutes (25+ minutes threshold noted) |
| 99232 | Subsequent hospital care, typically 25 minutes (35+ minutes threshold noted) |
| 99233 | Subsequent hospital care, typically 35 minutes (50+ minutes threshold noted) |
| 99234 | Same day admission and discharge, typically 30 minutes (45+ minutes threshold noted) |
| 99235 | Same day admission and discharge, typically 60 minutes (70+ minutes threshold noted) |
| 99236 | Same day admission and discharge, typically 80 minutes (85+ minutes threshold noted) |
| 99238 | Hospital discharge day management, 30 minutes or less |
| 99366 | Medical team conference with interdisciplinary team and patient/family present (physician) |
| 99367 | Medical team conference without patient present (physician) |
| 99368 | Medical team conference with interdisciplinary team and patient/family present (non-physician) |
| 99441 | Telephone evaluation and management service by a physician, 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service by a physician, 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service by a physician, 21-30 minutes of medical discussion |
Billing Permissions and Requirements
PCMP Billing Permission for HBAI and CoCM
Effective 7/1/2025, Primary Care Medical Providers (PCMPs) may bill Health Behavior Assessment and Intervention (HBAI) codes and Collaborative Care Model (CoCM) codes to Elevate Medicaid Choice for reimbursement.
- Affected codes: HBAI and CoCM (per Colorado behavioral health code set guidance)
- Effective date: 2025-07-01
E&M Billing Requirement
Evaluation & Management (E&M) claims billed to Elevate Medicaid Choice must include a behavioral health diagnosis and must be billed by a behavioral health specialist to be covered. Elevate Medicaid Choice will pay covered E&M codes (including allowable BH add-ons) with no visit limits when these conditions are met.
- Claim must include a Behavioral Health diagnosis (not a medical-only diagnosis, e.g., broken arm).
- Billed by a behavioral health specialist (provider type consistent with behavioral health services).
- No visit limitations on covered E&M codes when billed correctly.
- See Colorado HCPF State Behavioral Health Services Billing Manual for additional billing guidance: HCPF.Colorado.gov/Billing-Manuals
- Covered E&M codes include (examples): 99202, 99203, 99204, 99205, 99211, 99212 (per time-based descriptors)
Key Terms
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