ModifiedOptumPolicy N/A

Behavioral Health Integration Services

Defines coverage, provider requirements, service components, and coding for Behavioral Health Integration (BHI) services including Psychiatric Collaborative Care Model (CoCM) and general BHI; applies to clinicians and billing practitioners delivering these monthly, time-based services. Affects physicians and non-physician practitioners billing BHI to Optum/Medicare.

Policy Summary

PayerOptum

PolicyBehavioral Health Integration Services

Policy CodePolicy N/A

Change TypeAdded HCPCS add-onsDMHT codes

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionObtain and document advanced patient consent before starting BHI services and supervise care team services under general supervision.

SourceLink

POLICY UPDATE CHANGES

Three new optional add-on HCPCS codes for general behavioral health integration and psychiatric collaborative care model services when provided with advanced primary care management services were added.

Three new HCPCS codes (G0552, G0553, G0554) for digital mental health treatment were established effective January 1, 2025.

2types of BHI services covered (CoCM and general BHI)

70CoCM initial month threshold

60CoCM subsequent month threshold

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DMHT codes (G0552–G0554)

3APCM add-on HCPCS (effective Jan 1, 2026)

Coverage and Medical Necessity Criteria

BHI Coverage Criteria

Covered when ALL of the following team, patient eligibility, and service-component requirements are met:

ALL of the following

BHI is a monthly, time-based care management service integrated with other care (including primary care).
An initiating visit must establish the patient's relationship with the billing practitioner before starting BHI (examples: AWV, IPPE, qualifying E/M, TCM, or psychiatric diagnostic evaluation).

ALL of the following

Patient has an identified mental, behavioral, or psychiatric health condition (including substance use disorder) and requires assessment, care planning, or intervention; conditions may be pre-existing or diagnosed/refined over time.

ALL of the following

Team composition — ONE of the following applies
- Psychiatric Collaborative Care Model (CoCM): treating (billing) practitioner + behavioral health care manager + psychiatric consultant with regular caseload/systematic case review (weekly).
- General BHI: treating (billing) practitioner with clinical staff or behavioral health care manager providing monthly services; a psychiatric consultant may be used but is not required.

ALL of the following

Provides initial assessment, administers validated rating scales, maintains registry and proactive systematic follow-up, assesses adherence/tolerability/response, delivers brief evidence-based psychosocial interventions, and documents care and registry entries.
For CoCM, behavioral health care manager provides at least 70 minutes in the first calendar month and at least 60 minutes in subsequent months (additional 30-minute add-on increments available).

ALL of the following

Regularly reviews clinical status during systematic caseload reviews with the behavioral health care manager and advises on diagnosis and treatment adjustments; assists with treatment changes or referral to specialty care when needed.

ALL of the following

Services performed by care team members under the billing practitioner are assigned general supervision under the PFS; state law, licensure, and scope of practice apply.
Obtain advanced patient consent before starting BHI (verbal consent is acceptable if documented in the medical record); inform patients about cost sharing as applicable.
Document initiating visit, registry enrollment, ongoing tracking, and weekly caseload consultation (CoCM).

ALL of the following

ONE of the following ends a CoCM episode
- Patient meets treatment goals documented in the plan.
- Patient is referred for direct psychiatric care due to inadequate response to CoCM.
- There is a 6-month break in CoCM services for the patient.

ALL of the following

Bill appropriate CoCM or general BHI codes per published time thresholds; administrative/clerical time is excluded from billable time.
Do not report general BHI codes in the same month as psychiatric CoCM codes for the same patient (mutually exclusive for that month).

ALL of the following

Billing practitioners may be physicians or nonphysician practitioners (PA, NP, CNS, CNM) who direct BHI services and bill per applicable codes. Separate payments are made to physicians and NPPs supplying BHI services during a calendar month.

ALL of the following

Maintain a registry for patients receiving BHI and document follow-up, interventions, and outcomes to support billed services and caseload reviews.

ALL of the following

General BHI may be appropriate when care models do not involve a psychiatric consultant or behavioral health care manager; CoCM is required when the psychiatric collaborative care model is used.

ALL of the following

Apply CPT and HCPCS codes and their time-based thresholds as described in the coding guidance (e.g., 99492/99493/99494/G2214 for CoCM; 99484/G0323 for general BHI).

Operational note: Ensure state licensure and scope of practice for care team members furnishing services 'incident to' the billing practitioner are satisfied and documented.

Coverage and billing criteria

General coverage principles, exclusivity rules, and billing requirements:

ALL of the following

You may not report general BHI codes in the same month as psychiatric CoCM codes for the same patient; over multiple months, either approach may be appropriate depending on clinical need.

ALL of the following

We make separate payments to physicians and NPPs supplying general BHI services during a calendar month; CPT time rules apply to billed services.

ALL of the following

An initiating visit is required to begin BHI and may include AWV, IPPE, TCM, other qualifying E/M visits, or a psychiatric diagnostic evaluation as applicable.

ALL of the following

DMHT coverage criteria

Coverage and billing criteria for Digital Mental Health Treatment (DMHT) services — billable when ALL of the following are met:

ALL of the following

Billing practitioner supplies an FDA‑approved DMHT device as part of an ongoing treatment plan and bills G0552 for device supply and initial education/onboarding per course of treatment.

ALL of the following

Bill G0553 for the first 20 minutes of monthly treatment management and G0554 for each additional 20 minutes; billed time must include physician/qualified professional review of patient-specific DMHT data and at least one interactive communication with the patient or caregiver in the calendar month.

ALL of the following

G0553 and G0554 may be billed only while the patient is actively using the DMHT device during the calendar month.

ALL of the following

Codes, Time Thresholds, and Billing Rules

Psychiatric CoCM codesCPTCovered

99492	Initial Psychiatric CoCM — first 70 minutes in first calendar month
99493	Follow-up Psychiatric CoCM — first 60 minutes in subsequent month
99494	Add-on for each additional 30 minutes in a calendar month (with 99492/99493)
G2214	Initial & Subsequent Psychiatric CoCM — covers first 30 minutes in a month (HCPCS)

BHI/CoCM/DMHT codingmixedCovered

G2214	Initial or subsequent psychiatric CoCM — first 30 minutes/month of behavioral health care manager activities in consultation with psychiatric consultant
99492	CoCM first month — 70 minutes behavioral health care manager or clinical staff threshold
99493	CoCM subsequent months — 60 minutes behavioral health care manager or clinical staff threshold
99494	CoCM add-on — each additional 30 minutes per calendar month
99484	General BHI — at least 20 minutes of clinical staff time per calendar month
G0323	Care management services (clinical psychologist or clinical social worker) — at least 20 minutes/month; 90791 serves as initiating visit
G0552	DMHT device supply and initial education/onboarding per course of treatment
G0553	First 20 minutes monthly DMHT treatment management; requires at least one interactive communication
G0554	Each additional 20 minutes monthly DMHT treatment management; requires at least one interactive communication

DMHT HCPCS codesHCPCSCovered

G0552	Supply of a digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan
G0553	First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the DMHT device, including review and at least one interactive communication
G0554	Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the DMHT device, including review and at least one interactive communication

Time thresholds for billing — CoCM

Initial month threshold70 minutes required for CPT 99492 (initial Psychiatric CoCM)

Subsequent month threshold60 minutes required for CPT 99493 (follow-up Psychiatric CoCM)

Add-on incrementsEach additional 30 minutes billed with CPT 99494 as an add-on to 99492/99493

HCPCS alternativeG2214 covers initial or subsequent 30-minute unit for psychiatric CoCM

Assumed billing practitioner timeSee coding summary for assumed practitioner minutes per code (e.g., 99492 assumed 30 min; 99493 assumed 26 min; 99494 assumed 13 min)

Provider Responsibilities, Consent, and Billing Actions

Documentation Required

Consent and Supervision

Before starting behavioral health integration (BHI) services obtain advanced patient consent for interprofessional consultation and crisis/safety communications. Written consent is not required — verbal consent is acceptable but must be documented in the medical record. A new consent is required only if the patient changes billing practitioners. Inform patients that cost sharing applies to both face-to-face and non-face-to-face services.

Verbal consent permitted but must be documented in the medical record
New consent required only if the patient changes billing practitioners
Patients must be informed that cost sharing applies to face-to-face and non-face-to-face services

Documentation Required

Interprofessional consultation and crisis care consent and reporting

Interprofessional tele/e-consults and crisis care services require documented patient consent prior to billing. Use the HCPCS interprofessional consultation codes (G0546–G0551) for EHR-based or remote consults and G0560/G0544 for safety planning and post-crisis follow-up. Document consent and follow program-specific crisis reporting and follow-up protocols (including telephone follow-up rules for G0544).

Key Definitions

BHI — definition

DefinitionBehavioral health integration (BHI) — integrating behavioral health care with other care (including primary care) delivered as monthly, time-based care management services

Service componentsIncludes an initiating visit, care team services provided 'incident to' the billing practitioner, and may be single encounters or monthly services

EligibilityPatients with an identified mental, behavioral, or psychiatric health condition who require assessment, planning, or interventions

Psychiatric CoCM — definition

DefinitionPsychiatric Collaborative Care Model (CoCM) — a team-based BHI model delivered by a primary care team including a treating practitioner, behavioral health care manager, and psychiatric consultant

Core services

Policy Summary

PayerOptum

PolicyBehavioral Health Integration Services

Policy CodePolicy N/A

Change TypeAdded HCPCS add-onsDMHT codes

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionObtain and document advanced patient consent before starting BHI services and supervise care team services under general supervision.

SourceLink

On This Page

Three optional APCM add-on HCPCS codes (G0568, G0569, G0570) are available starting January 1, 2026 when billed with an APCM base code (G0556/G0557/G0558) and when all APCM requirements are met; base APCM code must also be billed that month.

ALL of the following

Interprofessional consultation codes (G0546–G0551) and crisis care services require documented patient consent for electronic/telehealth consultations; safety planning (G0560) is billed in 20-minute increments by the billing practitioner; post-crisis telephone follow-up (G0544) follows protocol and covers up to four calls per calendar month.

ALL of the following

HCPCS G0323 requires a psychiatric diagnostic evaluation (CPT 90791) to serve as an initiating visit when applicable for care management services for behavioral health conditions.

ALL of the following

DMHT codes (G0552–G0554) introduce device supply and monthly management rules; see DMHT coverage criteria for device and active-use requirements.

ALL of the following

Time-based thresholds for CoCM and general BHI are explicit (see coding summary): CoCM initial 70 minutes (99492), subsequent 60 minutes (99493), add-on 30-minute increments (99494/G2214); general BHI at least 20 minutes (99484/G0323). Administrative or clerical time cannot be counted toward billed clinical time thresholds.

The billing practitioner must cover the cost of obtaining and supplying the DMHT device and document that supplying the device is part of their services under an ongoing treatment plan.

ALL of the following

Medicare will monitor use of DMHT devices and providers should consult their Medicare Administrative Contractor for additional implementation details.

Minimum monthly clinical staff behavioral health time thresholds

CoCM initial monthBehavioral health care manager or clinical staff time threshold = 70 minutes (CPT 99492)

CoCM subsequent monthsBehavioral health care manager or clinical staff time threshold = 60 minutes (CPT 99493)

CoCM add-onEach additional 30 minutes of behavioral health care manager time billed with CPT 99494 or counted as 30-minute HCPCS G2214 unit

General BHI thresholdAt least 20 minutes of clinical staff time per calendar month (CPT 99484 or HCPCS G0323)

Monthly active-use requirement for DMHT codes

Active-use requirementHCPCS G0553 and G0554 may be billed only when the patient is actively using the DMHT device during the calendar month

Interactive communicationG0553/G0554 require at least one interactive communication with the patient or caregiver in the calendar month

Device supply and onboarding separateG0552 covers supply and initial education/onboarding per course of treatment and is distinct from monthly management codes

Document patient consent in the medical record before billing interprofessional consultation codes
Use G0546–G0551 for interprofessional EHR/remote consultation services
Use G0560 for safety planning (20-minute increments) and G0544 for post-crisis follow-up (up to 4 calls/month per bundled crisis care protocols)

Billing Rule

APCM add-on billing requirement

When billing Advanced Primary Care Management (APCM) base codes (G0556, G0557, or G0558) in the same month as general BHI or psychiatric CoCM services, you may also bill the optional APCM add-on HCPCS codes beginning January 1, 2026. The optional add-on codes are not time-based and require that an APCM base code be billed in the same month.

Effective 2026-01-01: G0568 and G0569 — psychiatric CoCM services delivered to patients also receiving APCM services
Effective 2026-01-01: G0570 — general BHI services delivered to patients also receiving APCM services
Requirement: bill an APCM base code (G0556, G0557, or G0558) in the same month to use these add-on codes

Billing Rule

DMHT HCPCS billing and usage

Digital Mental Health Treatments (DMHTs) have specific HCPCS codes and billing rules effective January 1, 2025. Bill G0552 for supply of an FDA-approved DMHT device and initial education/onboarding (per course of treatment). Bill G0553 for the first 20 minutes of monthly DMHT-related treatment management and G0554 for each additional 20 minutes in the same calendar month. The billing practitioner must supply and cover the cost of the device as part of an ongoing treatment plan, and G0553/G0554 are billable only when the patient is actively using the device.

G0552 — Supply of FDA-approved DMHT device and initial education/onboarding, per course of treatment
G0553 — First 20 minutes of monthly DMHT treatment management; requires at least one interactive communication with patient/caregiver in the month
G0554 — Each additional 20 minutes of monthly DMHT treatment management; requires at least one interactive communication in the month
Billing practitioner must procure and supply the FDA-approved device and include supply as part of services under an ongoing treatment plan
G0553/G0554 may be billed only if the patient is actively using the DMHT device

Care management support and regular psychiatric inter-specialty consultation for patients not improving with usual care

Team compositionTeam of three: behavioral health care manager, psychiatric consultant, and treating (billing) practitioner

Behavioral health care manager — definition

DefinitionBehavioral health care manager — designated provider with formal education or specialized training in behavioral health (e.g., social work, nursing, psychology) working under the billing practitioner's oversight

Key dutiesAdministers validated rating scales, develops and updates care plans, delivers brief psychosocial interventions, maintains registry, consults with psychiatric consultant

ScopeHas a continuous relationship with the patient and may deliver face-to-face services; administrative/clerical time is excluded from billable thresholds

Psychiatric consultant — definition

DefinitionPsychiatric consultant — medical provider trained in psychiatry and qualified to prescribe the full range of medications

RoleRegularly reviews clinical status, advises on diagnosis and treatment adjustments, recommends management of treatment interactions, and typically works remotely with limited direct patient contact

Referral roleCan and should offer referral for direct psychiatric care when clinically indicated

Treating (billing) practitioner — definition (short)

Definition (short)Treating (billing) practitioner — a physician or non-physician practitioner (NPP) who directs BHI services and typically practices in primary care

ExamplesIncludes physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives

ResponsibilityEstablishes initiating visit and directs care team services delivered 'incident to' their direction

Treating (billing) practitioner — definition (alternate)

Definition (alternate)Treating (billing) practitioner — a physician or NPP (PA, NP, CNS, CNM) who typically practices in primary care but may be in another specialty and directs BHI services

ScopeMay be in specialties such as cardiology, oncology, or psychiatry; responsible for directing BHI and authorizing care team activities

Billing implicationBHI services the practitioner doesn't personally perform are assigned general supervision under the PFS

Patient — definition

DefinitionPatient — a member of the care team receiving BHI services

Eligibility notePatients eligible for BHI have identified mental, behavioral, or psychiatric conditions and require assessment, planning, or intervention

Care relationshipPatient is managed through initiating visit and ongoing monthly services, tracked in a registry when applicable

Behavioral Health Care Manager — expanded definition and role

Expanded roleBehavioral Health Care Manager provides assessment, care planning, brief interventions, maintains the registry, consults with psychiatric consultant, and maintains a continuous patient relationship

Operational detailsAdministers validated rating scales, revises care plans for non-progressing patients, collaborates continuously with billing practitioner, and may work outside regular hours as needed

Billing exclusionTime spent solely on administrative or clerical duties is not counted toward the billable time thresholds

Psychiatric Consultant — expanded definition and role

Expanded rolePsychiatric Consultant regularly reviews patients' clinical status, advises on diagnosis and treatment adjustments, manages treatment interactions, and recommends referrals for direct psychiatric care when indicated

Typical contactOften remotely located and not generally expected to have direct patient contact or to prescribe/directly treat as part of routine consultation

Consultation dutiesProvides recommendations to the treating practitioner and behavioral health care manager and assists with treatment modifications for non-responsive patients

Clinical Staff — definition and scope

DefinitionClinical Staff — care team members who maintain a continuous relationship with the patient and provide integrated care under direction of the billing practitioner

Scope of billable timeIncludes behavioral health care manager or other clinical staff time but excludes administrative/clerical time from billable thresholds

Examples and limitsMay include clinical psychologists or clinical social workers (e.g., for G0323) and may or may not meet independent Medicare billing requirements

DMHT device requirement

FDA approvalThe DMHT device must be FDA-approved to bill HCPCS code G0552

Supply and costThe billing practitioner must supply the device and cover the cost of getting and supplying it as part of an ongoing treatment plan (G0552)

Use requirementG0553 and G0554 are allowed only while the patient is actively using the DMHT device and require at least one interactive communication per calendar month