New payment process for BHCC & CM telephone management services
Update 5/22/24: Modifier 25 should only be appended to claims for CM telephone management services provided on the same day as another E/M.
In response to provider requests, we’re updating how we pay PCPs for behavioral health collaborative care (BHCC) services and care management telephone management services for the plan types listed below.
Following the timelines and billing advice listed below, we’ll now pay for the services by paper check, batching payments 60 days at a time.
| Service type | Why | Effective date |
| BHCC | BHCC services for fully funded commercial members have historically included member liability. This new process will waive member copays and deductibles. | July 1, 2023 |
| Care manager telephone management |
These services were denied, per CPT guidelines, when provided:
|
Jan. 1, 2023 Providers can rebill denied claims for services dating back to 1/1/23. |
Why did we make this change?
We know how important it is for our members, your patients, to receive these services. This new payment process allows us to ensure these important services are both covered and without member liability, bypassing payment system configurations that can’t be changed in these cases.
What do your providers need to do?
- Stop collecting member copays for BHCC services.
- Follow the updated billing process for the care manager telephone management codes, to ensure payment.
- Be aware of the updated payment process.
Will this change impact PIP?
No, this change won’t impact your ACN’s PCP Incentive Program (PIP) participation or payout. The BHCC codes will continue to count towards the BHCC measure, and the care manager telephone management codes will continue to count towards the care management measure’s two touchpoints for 2% of your ACN’s population, even if the updated billing advice isn’t followed.
What does the new payment process look like?
We'll continue to pay you your normal rate for these services, but payment will be batched every 60 days and sent as a paper check to the provider’s claims remittance advice (RA) address.
You’ll continue to receive individual RAs for each submitted claim, now with a code that says: “No compensation allowed for this service – reporting only.” This is because we’re applying a $0 initial payment and then making the payment “offline” via check.
Impacted codes & billing
| Code | Description | Impacted plan types | How to bill |
| BHCC | |||
| 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 professional 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 |
Fully funded commercial only. (Medicare and Medicaid have never included member liability.) |
EFFECTIVE JULY 1, 2023. No change to billing. Bill as you always have. The new payment process will be automatically applied. Note: Stop collecting member copays for these services. |
| 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 | ||
| 99494 |
Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care management activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health professional (List separately in addition to code for primary procedure) | ||
| G2214 |
Initial or subsequent psychiatric collaborative care management, first 30 minutes in a 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 | ||
| Care manager telephone management | |||
| 98966 |
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion |
All fully funded commercial, Medicare, Medicaid Verify coverage for self-funded commercial members |
EFFECTIVE JAN. 1, 2023. These codes will now be covered when billed:
Append modifier 25 to claims for CM telephone management services provided on the same day as another E/M to trigger the new payment process. Providers can rebill denied claims for these services for dates of service on or after Jan. 1, 2023. |
| 98967 |
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment: 11-20 minutes of medical discussion | ||
| 98968 |
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment: 21-30 minutes of medical discussion | ||
|
Additional care management codes These codes were already, and will continue to be, paid through this process. |
|||
| G9001 | Coordinated care fee, initial rate | Fully funded commercial only |
No change to billing. Bill as you always have. |
| G9002 | Coordinated care fee, maintenance rate | ||
| G9007 | Coordinated care fee, scheduled team conference | ||
| G9008 | Coordinated care fee, physician coordinated care oversight services | ||