Talk with us CARE PROGRAM GUIDE · BHI
Behavioral Health Integration
The medical team helps follow a patient’s mental-health needs alongside their other care, so questions and treatment changes reach the right clinician.
FIRST, THE SHORT ANSWER
What would BHI add to care?
Medicare describes general BHI and psychiatric Collaborative Care Model (CoCM) as distinct approaches. Both require a treating practitioner and ongoing team-based work; CoCM also requires a psychiatric consultant and a defined care-manager/registry process.
A home monitoring device is not required. General BHI needs reliable care-plan and time records; CoCM additionally needs a registry and validated measures to track progress and caseload review.
PATIENT & PRACTICE FIT
Could this help people you treat?
Potential fit
A patient with an identified behavioral, mental-health, psychiatric, or substance-use condition for whom the treating practitioner determines integrated follow-up is clinically appropriate.
Check before enrolling
No documented consent or behavioral-health care plan; no eligible team; or describing CoCM without a psychiatric consultant, registry, and required caseload consultation.
PATIENT EXPERIENCE
The patient receives a care plan, symptom or outcome follow-up, help navigating behavioral and medical treatment, and escalation to the treating clinician when needed.
SEE IT IN PRACTICE
Care between visits, step by step.
Meet Sam: his primary-care clinician identifies depression and wants coordinated follow-up on symptoms and access to treatment.
The goal: Follow Sam’s response to the agreed plan and close gaps in treatment access.
Choose a stage to see what the patient, treating practice, and PrimeVital’s agreed team each do.
Choose the model
Before enrollment- Patient / caregiver
- Discusses consent, costs, and information sharing.
- Treating practice
- Assesses the condition and establishes the initiating relationship.
- PrimeVital’s agreed role
- Helps evaluate general-BHI operations and the required team.
- What gets recorded
- Condition, initiating visit, consent, and general BHI versus CoCM selection.
Illustrative scenario, not a patient record or clinical protocol. Clinical targets, review frequency, staff qualifications, escalation, and service hours are agreed with the treating practice. Clinical decisions stay with qualified personnel.
SAMPLE CARE PLAN
A plan the patient and the team can understand.
Follow Sam’s response to the agreed plan and close gaps in treatment access.
- Patient task
- Discuss symptoms, treatment concerns, preferences, and barriers.
- Clinical owner
- The treating practitioner chooses the care model and makes clinical decisions.
- Team follow-up
- Use appropriate measures, coordinate treatment, and route concerns through the agreed clinical escalation process.
- Review
- Review progress and update the plan when symptoms or circumstances change.
After launch: the continuing period
Repeat purposeful follow-up and revise the plan as needed. CoCM requires a separately established psychiatric consultant, care-manager, registry, and caseload-review model; it is not automatically included in general BHI.
YOUR INVOLVEMENT
Clinical ownership stays with the treating practice.
The agreement names the people, work, coverage hours, records access, and handoffs. Technology and operational support do not transfer clinical or billing authority.
What your clinician does
An eligible treating physician or qualified practitioner bills the applicable BHI or CoCM service and directs the team. Provider-type rules differ by code.
What supporting staff can do
For general BHI, qualified clinical staff may furnish applicable care-management work under direction. CoCM uses a behavioral-health care manager and psychiatric consultant in a defined collaborative model.
What we can organize with you
PrimeVital can help evaluate and operate agreed general-BHI workflows. CoCM would require a qualified psychiatric-consultation partnership, care-manager capacity, registry, and formal clinical governance before launch.
PrimeVital’s full care arrangement includes applicable devices and a care-management team. The program determines which resources and professional qualifications are needed. Interactly can support front-desk tasks within the agreed scope; 24/7 PrimeVital clinical coverage is not assumed.
REQUIREMENTS BEFORE LAUNCH
Make the pathway ready before enrolling patients.
- Complete the initiating visit/relationship assessment and identify general BHI or psychiatric CoCM; do not mix the models.
- Confirm consent, treating practitioner, care plan, team roles, and qualifying time.
- For CoCM, secure a psychiatric consultant, behavioral-health care manager, registry, and caseload review.
- Check behavioral-health carve-outs and any APCM add-on prerequisites.
Detailed operating workflow and technology
- 1
Assess
Identify the condition, obtain advance consent, and choose general BHI or CoCM based on the available model.
- 2
Plan
Create behavioral-health goals and a follow-up schedule with the treating practitioner.
- 3
Coordinate
Provide care-management contacts and measured follow-up; in CoCM, use registry and psychiatric caseload consultation.
- 4
Review
Record time, interventions, consultant input, response, and the correct monthly code.
Technology and records: A home monitoring device is not required. General BHI needs reliable care-plan and time records; CoCM additionally needs a registry and validated measures to track progress and caseload review.
GETTING PAID
Who receives payment, and what earns it?
Care need, completed services, evidence, and the actual payer determine the claim. A covered service or an enrollment is not the same as collected revenue.
The eligible treating practitioner bills the code matching the actual BHI model and work. General BHI, CoCM, and APCM behavioral-health add-ons have different requirements. PrimeVital’s scope and fees are defined in the service agreement.
Original Medicare Part B recognizes eligible general BHI and psychiatric CoCM. The code and team model must match; they are not interchangeable.
Confirm behavioral-health carve-outs, network rules, delegated entities, telepsychiatry arrangements, and each plan’s coverage and authorization requirements.
Part B cost sharing may apply under Original Medicare. Explain it in the advance consent process and check secondary coverage.
Payment boundaryCoCM requires a separately confirmed psychiatric consultant and the full care-manager, registry, and review model. CMS added optional 2026 BHI/CoCM add-ons with APCM; the applicable code combination needs specific review.
2026 code reference and an illustrative service check
General BHI and CoCM have different team and time requirements. A screening score alone is not the general-BHI service. CoCM cannot be modeled without its psychiatric consultant, care manager, registry, and required collaboration.
These are code-family summaries, not complete descriptors or payment estimates. Check the current code set, payer, clinician, setting, date, unit edits, and required add-on base code.
| Code / pathway | What it describes | Before billing |
|---|---|---|
| 99484 | General BHI | At least 20 minutes of qualifying clinical-staff care-management work in a calendar month and required service elements. |
| G0323 | General behavioral-health care management | At least 20 minutes of eligible clinical-psychologist or clinical-social-worker time; verify the practitioner and setting. |
| 99492 / 99493 / 99494 | Psychiatric CoCM | Initial, subsequent, and additional-monthly-time pathways; check care-manager and consultant elements. |
| G2214 | Shorter-duration CoCM pathway | Review the current code requirements and practice setting before use. |
| G0568 / G0569 / G0570 | Optional APCM behavioral-health add-ons | The first two describe CoCM and G0570 general BHI with an APCM base code reported by the same practitioner in the same month; do not treat them as stand-alone BHI codes. |
Questions before a claim
Are BHI and CoCM the same?
No. CoCM has additional psychiatric-consultation, care-manager, registry, and caseload-review requirements.
Does PrimeVital already provide CoCM?
Do not assume so. The required clinical partnership and operating model must be established and confirmed for a specific engagement.
FINANCIAL PICTURE
See how participation, collections, and costs change the result.
Start with one supported pathway. Do not multiply every patient by every possible code. Use verified payer terms and the written PrimeVital scope before making a business decision.
Illustrative BHI model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. PrimeVital pilot terms are not modelled automatically. Replace them with your verified contract, service mix, and cost assumptions.
Estimate net after your agreed service fee and other costs
Enter the total fees from your written agreement. No fee is prefilled. Pilot service fees are paid from collections; treatment of denied or insufficient collections must be agreed before launch.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Illustrative collections before service and practice costs: $3,500. This uses the hypothetical per-patient amount and collection rate above; it is not a code-specific Medicare estimate.
To estimate the amount remaining for the practice, open the cost section and enter the total service fee from a written proposal. We do not invent a PrimeVital price or show a misleading net amount before that is known.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
BENEFITS TO MEASURE
Define success before the first patient starts.
Agree on a baseline and review period. These are measures to track, not promised results or guaranteed payment.
Response
Change in an appropriate validated symptom measure.
Access
Treatment referrals completed and unresolved barriers.
Coordination
Timely clinician handoffs and patient understanding.
PRIMARY SOURCES
Check the rule before a real claim.
Reviewed October 7, 2026 against current CMS guidance. These guides describe 2026 pathways; proposals for later years are not effective requirements. Coverage, contracts, scope, and patient facts can change the answer.
APPLY THIS TO YOUR PRACTICE
Start with a patient group and a clear question.
Tell us your practice type, payer mix, and workflow. We can map clinical fit, your involvement, available support, launch requirements, and financial assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
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