Request an assessment CARE PROGRAM FIELD GUIDE · BHI
Behavioral Health Integration
Medicare describes general BHI and psychiatric Collaborative Care Model (CoCM) as distinct approaches. Both require a treating practitioner and ongoing team-based work; CoCM also requires a psychiatric consultant and a defined care-manager/registry process.
FIRST, THE SHORT ANSWER
What is BHI, and where does it fit?
Behavioral Health Integration is one specific care or payment pathway—not a label for all remote outreach. These four facts determine whether it is worth a closer look.
A home monitoring device is not required. General BHI needs reliable care-plan and time records; CoCM additionally needs a registry and validated measures to track progress and caseload review.
PATIENT & PRACTICE FIT
Who is this for—and when should you stop?
Potential fit
A patient with an identified behavioral, mental-health, psychiatric, or substance-use condition for whom the treating practitioner determines integrated follow-up is clinically appropriate.
Pause and verify
No documented consent or behavioral-health care plan; no eligible team; or describing CoCM without a psychiatric consultant, registry, and required caseload consultation.
PATIENT EXPERIENCE
The patient receives a care plan, symptom or outcome follow-up, help navigating behavioral and medical treatment, and escalation to the treating clinician when needed.
PROVIDER, OPERATOR & PARTNER VIEW
Doing the work and billing for it are different roles.
Credential, state scope, supervision, enrollment, setting, and the actual payer contract govern participation. A job title alone does not establish billing authority.
Who directs care and submits the claim?
An eligible treating physician or qualified practitioner bills the applicable BHI or CoCM service and directs the team. Provider-type rules differ by code.
Who can perform supporting work?
For general BHI, qualified clinical staff may furnish applicable care-management work under direction. CoCM uses a behavioral-health care manager and psychiatric consultant in a defined collaborative model.
Where can PrimeVital help?
PrimeVital can help evaluate and operate agreed general-BHI workflows. CoCM would require a qualified psychiatric-consultation partnership, care-manager capacity, registry, and formal clinical governance before launch.
END-TO-END OPERATING MODEL
From the right patient to a documented clinical response.
Use this sequence to assign an owner and an evidence handoff before the first patient is enrolled.
- 01
Assess
Identify the condition, obtain advance consent, and choose general BHI or CoCM based on the available model.
- 02
Plan
Create behavioral-health goals and a follow-up schedule with the treating practitioner.
- 03
Coordinate
Provide care-management contacts and measured follow-up; in CoCM, use registry and psychiatric caseload consultation.
- 04
Review
Record time, interventions, consultant input, response, and the correct monthly code.
Technology and records: A home monitoring device is not required. General BHI needs reliable care-plan and time records; CoCM additionally needs a registry and validated measures to track progress and caseload review.
BILLING, INSURANCE & PATIENT COST
What can be billed—and what must be checked first?
These code labels are orientation, not complete descriptors or a reimbursement estimate. Confirm the current code set, payer policy, contract, date of service, clinician, setting, and claim edits.
Code / pathwayWhat it describesBefore billing
99484General BHI
At least 20 minutes of qualifying clinical-staff care-management work in a calendar month and required service elements.
G0323General behavioral-health care management
At least 20 minutes of eligible clinical-psychologist or clinical-social-worker time; verify the practitioner and setting.
99492 / 99493 / 99494Psychiatric CoCM
Initial, subsequent, and additional-monthly-time pathways; check care-manager and consultant elements.
G2214Shorter-duration CoCM pathway
Review the current code requirements and practice setting before use.
G0568 / G0569 / G0570Optional APCM behavioral-health add-ons
The first two describe CoCM and G0570 general BHI with an APCM base code reported by the same practitioner in the same month; do not treat them as stand-alone BHI codes.
Original Medicare Part B recognizes eligible general BHI and psychiatric CoCM. The code and team model must match; they are not interchangeable.
Confirm behavioral-health carve-outs, network rules, delegated entities, telepsychiatry arrangements, and each plan’s coverage and authorization requirements.
Part B cost sharing may apply under Original Medicare. Explain it in the advance consent process and check secondary coverage.
Do not overlook this boundaryPrimeVital should not advertise CoCM as an active service without the required psychiatric consultant and model components. CMS added optional 2026 BHI/CoCM add-ons with APCM; the applicable code combination needs specific review.
BEFORE A PILOT OR CLAIM
Four checks to make the pathway real.
- 1
Identify whether the practice is offering general BHI or psychiatric CoCM; do not mix the models.
- 2
Confirm consent, treating practitioner, care plan, team roles, and qualifying time.
- 3
For CoCM, secure a psychiatric consultant, behavioral-health care manager, registry, and caseload review.
- 4
Check behavioral-health carve-outs and any APCM add-on prerequisites.
Questions we hear
Are BHI and CoCM the same?
No. CoCM has additional psychiatric-consultation, care-manager, registry, and caseload-review requirements.
Does PrimeVital already provide CoCM?
Do not assume so. The required clinical partnership and operating model must be established and confirmed for a specific engagement.
PRIMARY SOURCES & CURRENCY
Check the rule before a real claim.
Reviewed September 27, 2026. This guide is educational. Coverage, coding, local contractor guidance, contracts, state scope, and patient facts can change the answer. PrimeVital and the treating organization should validate an actual pathway before launch.
APPLY THIS TO YOUR PRACTICE
Bring your patient mix, payer contracts, and current workflow.
We can map the clinical owner, work PrimeVital can support, implementation gaps, and what still needs payer or coding confirmation.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Choose how to connect
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