Introduction
The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Understanding these updates is crucial for behavioral health providers to ensure compliance, maximize reimbursements, and continue delivering high-quality care. This article discusses the latest changes, providing a comprehensive guide to navigating the evolving billing landscape.
Expanded Telehealth Services
One of the most notable changes in Medicare/Medicaid billing for behavioral health is the expanded coverage for telehealth services. In response to the COVID-19 pandemic, temporary measures were put in place to facilitate remote care. Recognizing the ongoing need for accessible mental health services, many of these changes have been made permanent. Behavioral health providers can now offer a broader range of services via telehealth, including Psychotherapy; Counseling; Psychiatric evaluations; and Medication management. Providers should ensure they are familiar with the specific telehealth billing codes and requirements to avoid claim denials and ensure proper reimbursement.
Integrated Behavioral Health Services
Medicare and Medicaid have also introduced new billing codes to support integrated behavioral health services within primary care settings. The Collaborative Care Model (CoCM), which promotes a team-based approach to managing behavioral health conditions, now has dedicated billing codes. These include:
- CPT Code 99492: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month.
- CPT Code 99493: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month.
- CPT Code 99494: Additional 30 minutes in a calendar month of psychiatric collaborative care management.
These codes recognize the importance of collaborative care in improving patient outcomes and offer a framework for billing these integrated services.
Substance Use Disorder (SUD) Treatment
Recent changes have also focused on improving access to treatment for substance use disorders (SUD). Medicare and Medicaid now cover a wider array of SUD treatment services, including Opioid Treatment Programs (OTPs); Medication-Assisted Treatment (MAT); and Counseling and behavioral therapies. Providers should be aware of the specific billing codes associated with these treatments, such as:
- G2067: Medication-assisted treatment, weekly bundle
- G2086: Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy
Behavioral Health Quality Payment Program (QPP)
The Quality Payment Program (QPP) has introduced new measures for behavioral health providers under the Merit-based Incentive Payment System (MIPS). These measures aim to improve the quality of care and patient outcomes. Providers need to be aware of the reporting requirements and the potential impact on their reimbursement rates.
Documentation and Compliance
With the changes in billing, there is an increased emphasis on accurate documentation and compliance. Behavioral health providers must ensure that their documentation supports the services billed and meets Medicare and Medicaid requirements. This includes:
- Detailed patient records
- Proper coding for services rendered
- Compliance with telehealth documentation guidelines
To conclude,
Staying informed about the recent changes in Medicare and Medicaid billing for behavioral health is essential for providers. By understanding and adapting to these updates, providers can ensure compliance, optimize reimbursements, and continue to deliver high-quality care to their patients. For those needing assistance navigating these changes, Medisys offers specialized billing services to help behavioral health providers manage their billing efficiently and effectively. For more information on how Medisys can assist you with your behavioral health billing needs, contact us today.
Reference Links:
- Centers for Medicare & Medicaid Services: List of Telehealth Services
- Centers for Medicare & Medicaid Services: MLN909432 Behavioral Health Integration Services Booklet
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