Anthem Integrated Medical and Behavioral Healthcare Reimbursement Policy Update

November 2017 ~

For dates of service on or after December 1, 2017, Anthem Blue Cross and Blue Shield (Anthem BCBS) will begin reimbursement for Psychiatric Care Collaborative Management Healthcare Common Procedure Coding System (HCPCS Level II) codes.

These behavioral health integration (BHI) billing codes represent care provided under the psychiatric Collaborative Care Model (CoCM) by a primary care team consisting of a treating physician (or other qualified health care professional, such as a nurse practitioner or physician assistant) and a behavioral health care manager working in collaboration with a psychiatric consultant (i.e. psychiatrist, licensed clinical social worker).

Anthem BCBS will provide reimbursement for the following codes, effective December 1:

  • G0502 – Initial psychiatric collaborative care management for the first 70 minutes in the first calendar month satisfying the following elements:
    • Patient outreach and engagement by the treating physician
    • Initial assessment of the patient and development of an individualized treatment plan
    • Review of the treatment plan by a psychiatric consultant and modification of the plan if recommended
    • Entry of the patient in a registry, follow-up tracking, and participation in weekly caseload consultation with the psychiatric consultant
    • Brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
  • G0503 – Subsequent psychiatric collaborative care management for the first 60 minutes in a subsequent month satisfying the following elements:
    • Tracking patient follow-up and progress using the registry, with appropriate documentation
    • Weekly caseload consultation with the psychiatric consultant
    • Ongoing collaboration and coordination of patient mental health care by the treating physician and any other treating mental health providers
    • Additional review of progress and recommendations for treatment changes
    • Brief interventions using evidence-based techniques
    • Monitoring of patient outcomes using validated rating scales, along with relapse prevention planning as the patient achieves remission of symptoms or other treatment goals
  • G0504 – Additional 30 minutes of behavioral health care manager activities in a calendar month, in consultation with a psychiatric consultant and directed by the treating physician.

 

Source(s): Anthem BlueCross BlueShield Network Update;

 

 

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