Reimbursements

Category:

Psychiatric Collaborative Care Services

Reimbursement Policy: NDRP-GC-017
Topic: Behavioral Health
Effective Date: December 1, 2017
Last Reviewed: September 9, 2019

 

Description:

This policy provides information on reimbursement for Psychiatric Collaborative Care.

Definitions:

Psychiatric Collaborative Care Services are provided under the direction of a treating physician or other qualified health care professional.

Policy

99492: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional. Please refer to the CPT® manual for the required elements.

  • Total duration of collaborative care management over the calendar month is 36-85 minutes. Time less than 36 minutes is not reported separately.
  • This code can be billed one time per month for all the work done in that month.
  • Time spent on activities for services reported separately are not included in the time applied to 99492.

99493: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional. Please refer to the CPT® manual for the required elements.

  • Total duration of collaborative care management over the calendar month is 31-75 minutes. Time less than 31 minutes is not reported separately.
  • This code can be billed one time per month for all the work done in that month.
  • Do not report 99492 and 99493 in the same calendar month.
  • Time spent on activities for services reported separately are not included in the time applied to 99493.

+99494: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional. (List separately in addition to code for primary procedure.)

  • Refer to the time requirement in the CPT®manual for total duration of collaborative care management over the calendar month.
  • This code can be billed one time per month with units reflecting the number of additional 30-minute increments of work done in that month.
  • This is an add-on code to 99492 and 99493.
  • Time spent on activities for services reported separately are not included in the time applied to 99494.

99483: Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home. Please refer to the CPT® manual for the required elements.

  • Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.
  • Do not report 99483 in conjunction with Evaluation and Management (E&M) services, psychiatric diagnostic procedures, psychological testing, neuropsychological testing, brief emotional/behavioral assessment, and medication therapy management services.
  • A single physician or other qualified healthcare professional should not report 99483 more than once every 180 days.

99484: Care-management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified healthcare professional, per calendar month. Please refer to the CPT® manual for the required elements.

  • General behavioral health integration care management services (99484) are reported by the supervising physician or other qualified healthcare professional.
  • This code can be billed one time per month.
  • Behavioral Health integration care management (99484) and psychiatric collaborative care management (99492, 99493, 99494) may not be reported by the same professional in the same month.

Cross Reference:

CPT® Guidelines

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.