Talk with us FOR YOUR PRACTICE · BEHAVIORAL & MENTAL HEALTH
PrimeVital can help qualified practices organize patient follow-up, symptom measures, clinical handoffs and billing evidence. The right workflow depends on whether you provide psychiatry, psychotherapy, integrated care or a combination.
START WITH YOUR CLINICAL MODEL
A behavioral-health specialty practice is not automatically a CoCM billing practice. Start with the treating clinician, actual services and payer contract.
Psychiatrists and other eligible E/M practitioners can evaluate general BHI (99484) when they direct the required monthly care-management service. Their own visits and treatment follow separate rules.
Understand general BHIClinical psychologists and clinical social workers have a distinct general-BHI route (G0323) when its requirements are met. Psychotherapy or screening alone does not establish that monthly service.
See roles and requirementsCounselors, marriage and family therapists, and other partners should start with their own covered services and contracts. They may also support a medical practice’s integrated-care workflow under a defined clinical and contractual arrangement.
Explore therapy practicesPsychiatric collaborative care is a separate team model: treating billing practitioner, behavioral-health care manager, psychiatric consultant, registry and regular case review. A psychiatrist may be the consultant for a partner practice; that does not make the consultant’s own practice the CoCM biller. PrimeVital would scope a CoCM engagement only after all clinical roles and governance are confirmed.
WHERE PRIMEVITAL FITS
We can support an agreed workflow without claiming to furnish psychotherapy, psychiatric consultation or emergency coverage.
The eligible practitioner chooses patients, defines the plan, reviews clinical concerns, makes treatment decisions and bills only supported services. The practice defines urgent and crisis pathways, qualified coverage and patient access.
PAYMENT EXAMPLE · SANTA CLARA COUNTY, CALIFORNIA
Original Medicare, October–December 2026, non-facility allowed amount. This example applies to an eligible physician or E/M practitioner furnishing general BHI—not to every behavioral-health professional or patient.
At least 20 minutes of qualifying clinical-staff time, plus the required assessment, care planning, treatment coordination and continuity under the billing practitioner.
Gross allowed amount before patient cost share, sequestration, denials, payer contracts, PrimeVital fees and practice costs. Not expected collections or margin.
G0323 for clinical psychologists or social workers, CoCM codes and professional visit codes have different requirements and economics; they are not added to this example. Verify payer coverage, practitioner type, setting and overlap before modeling a practice.
Sources: CMS Behavioral Health Integration Services, January 2026; CMS RVU26D and 2026 carrier file for the Santa Clara amount.
DESIGN A PRACTICAL STARTING POINT
