Behavioral Health and Opioid Treatment Reminders

Behavioral Health and Opioid Treatment Reminders

Medicare pays for services beneficial to the mental well-being of Medicare beneficiaries.  Those services include Psychotherapy for Crisis, Behavioral Health Integration including the Collaborative Care Model, and Opioid Use Disorder.

Psychotherapy for Crisis

  • 90839 - Psychotherapy for crisis; first 60 minutes
  • 90840 - Each additional 30 minutes
    • Includes urgent assessment and history of crisis state, mental status exam and psychotherapy, resources to reduce the crisis and restore safety, and providing interventions to minimize potential of psychological trauma.
    • Cannot bill other psychotherapy codes on same day.

Resources

Behavioral Health Integration (BHI) Services

  • 99484 - Behavioral Health Integration
    • Initial assessment, behavioral care planning, facilitating, and coordinating treatment, Pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated team member (at least 15 minutes)
  • G0323 - Care Management Services for Behavioral Health Conditions
    • Clinical Psychologist (CP), or Licensed Clinical Social Worker (LCSW) serves as focal point of care for integration of mental health services.
    • At least 20 minutes of CP or CSW time per calendar month
  • Who can provide counseling, individual, and group therapy included in the bundled payment - Licensed clinical social worker, Licensed professional counselors, or mental health counselor, Licensed marriage and family therapists, Licensed clinical alcohol and drug counselors, certified peer specialists or others permitted to give this type of therapy or counseling by state law and scope of practice. 

Collaborative Care Model (CoCM)

  • 99492 - Initial psychiatric collaborative monthly management; first 70 minutes
  • 99493 - Subsequent psychiatric collaborative management; first 60 minutes
  • +99494 - Initial, or subsequent psychiatric collaborative care management; each additional 30 minutes
  • Services can be provided by physician and non-physician practitioners who are eligible to furnish services for the diagnosis and treatment of mental illnesses. 

Resources

Opioid Use Disorder (OUD) Screening and Treatment Reminders

  • Medicare pays OUD screenings performed by physicians and non-physician practitioners.
    • OUD screening required element of Medicare’s Initial Preventive Physical Exam (IPPE) and Annual Wellness Visit (AWV)
    • During physician office and outpatient hospital settings, Medicare pays for Screening, Brief Intervention, & Referral to Treatment (SBIRT) treatment services
      • Evidence-based, early intervention approach for people with non-dependent substance use before they need more specialized treatment.
      • Depending on service duration, bill G2011 (5-14 minutes), G0396 (15-30 minutes), or G0397 (greater than 30 minutes)
      • Evaluation & Management (E/M) visits (99202-99499) for medication management (like buprenorphine) involving evaluating and managing patient health as part of recovery process.
  • Monthly office-based only services bundle overall management, treatment plan, coordinated care, individual and group psychotherapy, and substance use counseling.
    • Includes office-based Substance Use Disorder (SUD) Treatment Billing with three HCPCS for patient monthly bundling:
      • G2086 (first calendar month; at least 70 minutes),
      • G2087 (subsequent month; at least 60 minutes) and;
      • G2088 (coordinated care; more than 120 minutes)
        • For patients prescribed buprenorphine or naltrexone in office setting
  • Opioid Treatment Program (OTP) provides medication for opioid use disorder (MOUD), including methadone, buprenorphine, and naltrexone, as well as a range of other services including:
    • Individual and group therapy, substance use counseling, and toxicology testing for patients diagnosed with OUD.
    • Consider referring your patient to an OTP if specific MOUD helpful to their recovery
  • Learn more about covered OUD screening and treatment options, which includes a list of Medicare-enrolled OTPs.

Resources

 

Last Updated $dateUtil.getDate( $modifieddate , "MMM dd , yyyy" , $locale , $tzone )