Care Management for Behavioral Health
Definition
Services provided under the direction of a treating physician/NP/PA for work performed by a behavioral health care manager in consultation with a psychiatric consultant. A single, lump sum monthly payment to the primary care practice.
Explanation
These codes describe face-to-face and non-face-to-face services for patients with behavioral health conditions directed by the patient’s PCP, provided by a behavioral health manager and in consultation with a psychiatric consultant, who is an individual able to prescribe the full range of psychiatric medications.
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 directed to the behavioral health manager have signs or symptoms of their condition or may have a newly diagnosed condition, and may also need help in engaging in treatment or have not responded to standard treatment.
“These services are provided when a patient requires a behavioral health care assessment; establishing, implementing, revising, or monitoring a care plan; and provision of assessment; establishing, implementing, revising, or monitoring a care plan; and provision of brief interventions.”[1]
[1] Current Procedural Terminology 2020, Professional ed, p. 53
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