Behavioral Health Integration Billing: BHI and CoCM Codes 99484–99494

A large share of behavioral health care already happens in primary care. Practitioners write the first prescription for many antidepressants, manage anxiety alongside diabetes and hypertension, and field concerns patients raise first with a clinician they know. Behavioral health integration (BHI) codes pay for the structured team work behind that care: a care manager who follows up between visits, validated rating scales that measure progress, and a psychiatric consultant who advises the team.

These codes are frequently misunderstood — starting with who bills them. BHI and Collaborative Care Model (CoCM) services are billed by the primary care practice, under the treating practitioner's NPI, not by a therapist or psychiatrist billing therapy. This guide explains the two models, their codes and time thresholds, CoCM team roles and registry requirements, and the consent and time-tracking rules that decide payment.

How BHI Differs from Billing Therapy Services

BHI codes do not pay for psychotherapy, and are not an alternative way to bill counseling. Therapy and psychiatric services — diagnostic evaluations, individual and group psychotherapy, and related services in the 908xx family and other psychiatry ranges — are billed by the practitioners who furnish them, under their own credentials, for face-to-face encounters. That coding has its own rules, covered in our mental health billing guide.

BHI is different in kind. Under 99484 and the CoCM codes, the billing practitioner is the primary care practitioner directing overall care. The paid work is care management performed largely between visits by a behavioral health care manager, guided by a psychiatric consultant, and measured with validated rating scales. A patient can receive therapy and be managed under BHI at the same time — separate services, separately documented.

General BHI: CPT 99484

CPT 99484 describes general BHI care management. It is the simpler model and the right starting point for many practices, because it does not require CoCM's psychiatric consultant caseload review and registry — though it still requires a structured program, not informal follow-up.

Requirements for 99484:

• At least 20 minutes per calendar month of clinical staff time, directed by the billing practitioner, on behavioral health care management
• A behavioral health care manager — a team member with behavioral health training, working under the billing practitioner's direction
• An initiating visit with the billing practitioner establishing the service, where required
• Validated rating scales — standardized instruments, such as depression or anxiety scales, used at the start and to monitor progress, with results informing treatment adjustments
• Ongoing assessment and care planning — a care plan for the behavioral health condition, revised as status and scores change

99484 is billed once per month when the 20-minute threshold is met. Time below the threshold is not billable and cannot be carried between months. The typical patient has a condition managed in primary care — often alongside chronic medical conditions — without the full team below.

The Collaborative Care Model: CPT 99492–99494

The Collaborative Care Model is the more intensive model, for practices that can staff its full team. Medicare pays through three codes billed in sequence across an episode.

Code	Service period	Time threshold	What it covers
99492	First month (initial)	First 70 minutes in the initial month	Initial psychiatric collaborative care management, including assessment, care plan development, and registry entry
99493	Each subsequent month	First 60 minutes in the subsequent month	Ongoing collaborative care management, caseload review, and treatment adjustment
99494	Additional time in any month	Each additional 30 minutes beyond the 99492 or 99493 threshold	Add-on code billed with 99492 or 99493 when care management time exceeds the base threshold

CoCM thresholds are exacting. The base codes require the full stated minutes in the month, and 99494 add-on time is counted in defined increments, with partial increments below the midpoint not billable. Configure time tracking to the thresholds rather than estimating after the fact. Time cannot be banked across months.

CoCM is an episode model: 99492 opens it, 99493 continues it, until goals are met, the patient is referred, or the service ends. Restarts have their own rules — confirm them before billing 99492 again.

The CoCM Team: Roles and the Caseload Registry

CoCM payment depends on three defined roles. If one is missing, the model is not CoCM, and claims are exposed.

• Billing practitioner — the primary care practitioner who directs care, bills CoCM under their NPI, prescribes and adjusts treatment, and remains responsible for the service
• Behavioral health care manager (BHCM) — delivers most of the counted time: proactive follow-up, rating scales, brief behavioral interventions, care coordination, and the registry, under the billing practitioner's direction
• Psychiatric consultant — a psychiatrist or psychiatric nurse practitioner who advises the team, reviews patients not improving, and recommends treatment changes. The consultant usually does not see patients directly; their value is systematic caseload review

Binding the team together is the caseload registry — a tool listing every CoCM patient, their rating scale scores, and treatment status. It makes treat-to-target care possible: patients not improving are flagged for consultant review. A practice that cannot produce registry records has a serious audit problem, because the registry is core evidence CoCM occurred.

Consent and Time-Tracking Rules

Two administrative requirements decide most BHI claim outcomes.

Consent. The patient must consent before the service is billed. Explain that a care team including a psychiatric consultant may review their case, that information is shared within the team for treatment, and that cost-sharing may apply — these services are generally subject to deductible and coinsurance. Consent, verbal or written per payer policy, must be documented. A patient who declines cannot be billed, and work before documented consent should not be counted.

Time tracking. Both models are time-based monthly services. For each month billed, the record must show:

• The date of each care management activity
• The start and stop time, or total duration, of each activity
• Who performed it and what was done
• The running monthly total, tied to the threshold of the code billed

Only qualifying care management time counts. Time spent on separately billed services — a face-to-face office visit, for example — cannot be double-counted. A time log inside the EHR or registry that accumulates through the month and flags patients approaching a threshold keeps billing driven by recorded time, not month-end memory.

Which Patients Fit BHI and CoCM

These models fit primary care patients whose behavioral health condition needs structured management — most commonly a new diagnosis, a condition not improving on initial treatment, or a changing treatment plan. Depression and anxiety are most frequent, but other conditions managed in primary care can qualify when the need for care management is documented.

Patients well controlled on a stable regimen, with no active management need, are generally not a fit — there is no care management work to count. Patients whose needs exceed primary care — acute risk, or complex conditions requiring direct specialty treatment — should be referred to specialty care, which may still run alongside BHI coordination. Documenting the qualifying condition, rating scale baseline, and care plan at enrollment separates a defensible BHI panel from a list of names.

Elite Bill Care helps practices run BHI and CoCM billing inside Epic, athenahealth, eClinicalWorks, AdvancedMD, Tebra, and NextGen — time-threshold review, consent checks, and code selection before claims go out. With HIPAA-compliant processes, 10+ years of experience, and support in all 50 states, that underpins a 98% first-pass clean claim rate and up to 30% denial reduction.

Related pages

• Mental Health Billing Guide for Providers
• Mental Health / Psychiatry Medical Billing Services
• Primary Care Medical Billing Services
• Family Medicine Medical Billing Services

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