Behavioral Health

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While behavioral health and mental health are often used interchangeably, they represent distinct yet interconnected aspects of well-being. Behavioral health encompasses mental health but goes further by addressing the impact of daily habits, behaviors, and lifestyle choices on overall wellness. Treatment approaches in behavioral health often include behavior modification and lifestyle interventions.

Because these domains are deeply intertwined, comprehensive care plans typically integrate both to support lasting health outcomes.

Common CPT & HCPCS Codes

Psychotherapy & Counseling

  • Individual Therapy:
    • 90832 (30 min), 90834 (45 min), 90837 (60 min)
    • Add-on codes: 90833, 90836, 90838 (used with E/M services)
  • Group Therapy: 90853
  • Family Therapy: 90846 (without patient), 90847 (with patient)

Behavioral Health Integration (BHI) & Collaborative Care

  • General BHI: 99484
  • Psychiatric CoCM: 99492, 99493, 99494, G2214
  • Medicare CoCM: G0511, G0512

Preventive & Screening Services

  • Brief emotional/behavioral assessment: 96127
  • Preventive Counseling: 99401–99404
  • Tobacco Cessation Counseling: 99406–99407

Digital Mental Health & Crisis Services (Medicare 2025 Updates)

  • Safety Planning: G0560
  • Digital CBT Tools: G0552–G0554
  • Interprofessional Consults: G0546–G0551

Documentation Guidelines

General Requirements

  • Clearly document medical necessity, diagnosis, start/stop times, and interventions
  • Include treatment plans, progress notes, and patient response
  • Ensure legibility, signatures, and timely entries

Medicare-Specific

  • Must support CPT/HCPCS codes billed
  • Include mental status exams, pharmacologic management, and telehealth documentation

Medicaid-Specific

  • Follow state-specific definitions of medical necessity
  • Ensure stand-alone documentation for each encounter
  • Avoid billing undocumented or improperly coded services

Commercial Payers

  • Often follow CMS guidelines but may have additional requirements (e.g., Blue Cross requires detailed psychosocial history, medication reconciliation, and care coordination documentation)

Compliance Concerns

Common Pitfalls

  • Insufficient documentation (top reason for denials)
  • Incorrect code selection (e.g., billing individual therapy for group sessions)
  • Missing time-based elements
  • Improper use of modifiers or place-of-service codes

Audit Risks

  • Psychiatry ranks high in Medicare improper payments due to documentation errors
  • Medicaid audits focus on medical necessity, active treatment, and provider scope of practice

Policy Shifts

  • 2025 CMS updates emphasize value-based care, telehealth expansion, and digital mental health reimbursement

Commercial payers may lag in adopting crisis codes, creating coverage gaps.

We will be addressing each area of interest in a series of articles to follow. Stay tuned.

Next in our series: Psychiatry Services

Resources

Federal Register – Behavioral Health Services

Texas Medicaid – TMHP Behavioral Health Services Guide

CMS – Medicare & Mental Health Coverage IOM

Novitas – Behavioral Health Provider Page