New Care Management Services Billing Guidelines for Behavioral Health Providers

AAFCPAs would like to make behavioral health provider clients aware that, effective January 1, 2018, there are new billing guidelines for care management services. Billing changes for care management affect the following services:

• Cognitive-assessment services
• Psychiatric collaborative care model (CoCM)
• General behavioral health integration (BHI)

Note: These changes do NOT affect Federal Qualified Health Centers (FQHCs) or Rural Health Centers (RHCs).
Effective January 1, 2018, there are five new evaluation and management (E&M) codes, replacing the current G codes established in 2017. 
AAFCPAs urges clients to make all providers, coders, and medical billers aware of these new changes in order to avoid denials, as well as loss of provider and staff productivity, resources, and revenue.  Billing systems, including enterprise (or electronic) practice management (EPM) and electronic medical records (EMR), should be updated with these new codes and the old codes should be expired using correct expiration dates.
Billing changes are as follows:

• For cognitive-assessment services, report 99483 instead of G0505.
• For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
• For care management-focused behavioral health integration (BHI), report 99484 instead of G0507

Descriptions of the new E&M codes are:

• 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.
• 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.
• 99493 – Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities.
• 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities.
• 99484 – Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month.

The 2018 Medicare National payment amount for care management services are:

• 99483 $241.92
• 99484 $48.60
• 99492 $161.28
• 99493 $128.88
• 99494 $66.60

Please note: Payment amounts will vary slightly based on geographic location.
Please refer to the following Centers for Medicare and Medicaid Services (CMS) resource for additional information: Behavioral Health Integration Services >>

AAFCPAs can help facilitate these changes by:

• Providing 2018 revenue estimate
• Help with EPM and EHR system changes/updates
• Assist on reporting of coding and denials
• Assist with staff training

AAFCPAs can also perform a complete billing analysis, including but not limited to:

• Charge master examination
• Financial/data reporting
• Contract examination
• Process improvements
• Technology implementations
• Denial trend analysis
• Financial/cost analysis

AAFCPAs has spent over four decades providing incisive financial knowledge and strategic management advice to help our healthcare clients obtain optimal reimbursements, maintain regulatory compliance, increase cash flow, and sustain performance. Our Healthcare Practice, and integrated Business Performance, Internal Controls & IT Advisory Practice provides best practice recommendations and operational process reviews surrounding third-party billing and collection, accounts receivable management, reserve analysis, fee schedule analysis, business process improvement, and recommendations for implementing denial management processes.
If you have questions please contact Matt Hutt, CPA, CGMA, at 774.512.4043, mhutt@nullaafcpa.com; or your AAFCPAs Partner.