These codes are used for integrated behavioral health care services provided by a behavioral health care manager (BHM), under the supervision of the treating physician/non-physician practitioner (NPP), in consultation with a psychiatric physician or psychiatric NPP.
The treating physician, often a primary care provider (PCP) directs the work of a behavioral health care manager in consultation with a psychiatric physician, or NPP This recognizes the work and time of practitioners and staff in caring for patients with behavioral conditions outside of an E/M visit.
These services require an initiating visit by a physician or non-physician practitioner (NPP) who can perform E/M services as part of their scope of practice. CPT® uses the term qualified healthcare professional.
These patients “typically” have a newly diagnosed condition, according to the 2018 CPT® book, but may also need help in engaging in treatment or have not responded to standard treatment. It would seem from CPT® that the psychiatric condition isn’t required to be newly diagnosed.
Revised, Betsy Nicoletti 4/23/19