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Five Reasons to Offer Integrated Behavioral Health Services

As providers strive to address their patients’ physical and mental health, Integrated Behavioral Health services have gained popularity. These services, sometimes also known as Behavioral Health Integration (BHI), address behavioral health concerns through the patient’s primary care team.

Medicare has reimbursed for Behavioral Health Integration services since 2017 and continues to expand the list of BHI services they will reimburse for. More primary care providers now have the chance to offer BHI to their older patients.

Integrated Behavioral Health Services can make mental healthcare accessible to more patients and ensure patients receive care for all aspects of their health. And because Behavioral Health Integration comes in a variety of forms, your practice can choose one that works for you. Here are five reasons you might want to consider providing BHI to your patients. 

1. Integrated Behavioral Health Services Are Accessible 

Mental healthcare can be expensive and difficult to access, especially for lower-income patients. Integrated Behavioral Health services are offered through primary care providers, so patients can discuss their mental health needs with a provider they already visit. 

Medicare also reimburses for BHI services, including services through Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). This opens mental healthcare up to patients who might struggle to afford or locate it otherwise. 

Offering Integrated Behavioral Health services at a primary care office can also help patients who might be deterred by the cultural stigma of seeking out mental healthcare. By offering mental healthcare as part of primary healthcare, your practice can make mental healthcare less intimidating and more accessible. 

2. A Variety of Patients Can Benefit from Behavioral Health Integration 

BHI includes care for common conditions like depression and anxiety. But it can also address substance use disorders and less widely-diagnosed mental illnesses, like PTSD, OCD, bipolar disorder and schizophrenia. This means a large number of patients could potentially benefit from ongoing care. 

As the provider, you can use clinical judgment to determine when a patient might benefit from Integrated Behavioral Health services. You can implement Integrated Behavioral Health for patients who currently have a mental health diagnosis or for patients who have just received one. Behavioral Health Integration will then help you address the patients’ mental and physical healthcare at the same time. 

3. Integrated Behavioral Health Is Whole-person Care

Physical and mental health have a strong connection. Research shows that people with a chronic mental health condition are more likely to have a chronic physical health condition as well. 

Mental health struggles may make it more difficult for patients to: 

• Change exercise or nutrition habits
• Attend appointments or refill medications
• Try new activities or form new friendships
• Cut back on drinking or smoking 

Mental illness can also cause physical health problems. Depression can lead to fatigue, headaches, stomach pain, and insomnia, for example.

When providers and behavioral care managers have a holistic view of patients’ physical and mental health, they can address how physical and mental health conditions intersect. Integrated Behavioral Health services can help with this process.

If depression is preventing a patient from starting a new exercise routine, for example, a care manager can make sure they receive the medication or therapy they need. The patient might then be able to begin exercising and improve their physical conditions like high blood pressure or high cholesterol. 

4. Behavioral Health Integration Is Covered Under Medicare

Medicare has covered Behavioral Health Integration services since 2017, making ongoing mental healthcare potentially available to 66 million beneficiaries. If you believe a Medicare patient might benefit from BHI, you will need to record their verbal consent. 

Once they give this consent, your practice can bill BHI services using:

• CPT codes 99484, 99492, 99493, or 99494, depending on services rendered
• HCPCS codes G0323 or G2214, depending on services rendered

Medicare covers BHI, but you’ll need to make sure patients are aware that deductibles and copays may apply.

Depending on the form of BHI the Medicare patient participates in, they will have access to their primary care provider and additional care from a behavioral health manager, a psychiatric consultant, a clinical psychologist, or a therapist or social worker. Medicare reimburses for a variety of service models so you can choose the one that works best for your patients. 

5. Integrated Behavioral Health Services Come in Multiple Forms

CMS describes two forms of Integrated Behavioral Health services: the Psychiatric Collaborative Care Model (CoCM) and General BHI.

Psychiatric Collaborative Care Model (CoCM) 

The Psychiatric Collaborative Care Model is a specific form of BHI that includes two key services:

• Care management support for patients receiving behavioral health treatment 
• Regular psychiatric inter-specialty consultation

CoCM has much stricter restrictions about who can deliver the services than general BHI does. For CoCM, you will need a: 

• Behavioral Health Care Manager
• Psychiatric Consultant
• Treating (Billing) Practitioner

CoCM is often employed for patients with conditions that require medication management, like major depression. The Psychiatric Consultant is trained in psychiatry and qualified to provide medications, but does not have to see patients directly. Instead, they support the Treating Practitioner with medication and care recommendations.

The Treating Practitioner must be a physician, nurse practitioner or physician’s assistant who assumes responsibility for the patient’s care. They are often the primary care provider but could also be a specialist. 

The Behavioral Health care manager, who may be a nurse, a psychological counselor, or a social worker, is responsible for the patient’s care management services between their visits to the Treating Practitioner.

Under CoCM, there is some flexibility on who can perform each role: however, there is more flexibility under General BHI. 

General BHI

General BHI, another form of BHI covered by Medicare, must include: 

• Systematic assessment and monitoring 
• Care plan revision for patients whose condition isn’t improving adequately
• Continuous relationship with an appointed care team member

A psychiatric consultant does not have to be involved in General BHI, although they can be. The Treating (Billing) Practitioner can provide General BHI alone, or they can work closely with clinical staff who are nurses, social workers, psychological counselors or psychiatrists.

This model allows providers to give patients Behavioral Health Integration services, even when they don’t have a Psychiatric Consultant in place. 

Integrated Behavioral Health Services Let You Provide More Care

Offering Integrated Behavioral Health services at your practice can have a significant impact on the lives of your patients. By making mental healthcare more accessible, you can help Medicare beneficiaries improve their whole-person health. 

Medicare reimburses for a variety of BHI services, so you can choose the model that best suits your practice and your patients' medical needs. If you’d like to learn more about the benefits of Behavioral Health Integration, check out our provider’s guide to BHI.