Behavioral Health CPT Codes for 2023

Update: CMS announced the official release of the G0323 code (originally referred to as GBHI1 in this post), which allows clinical psychologists and clinical social workers to bill for behavioral health integration services. Read more about the requirements for the CPT code here.

The American Medical Association (AMA) is proposing two new billing codes to increase adoption of behavioral health integration (BHI) and promote technology that provides remote behavioral health care and monitoring. The codes are currently under review until September 9, and it’s expected that the Centers for Medicare & Medicaid Services (CMS) will adopt and implement them in January 2023.

What do the new billing codes mean for providers and plans? And what do they indicate for the future of integrated care? The codes will expand on existing BHI codes, like 99484 which is used for general BHI care management, and 99492 through 99494, which are used when delivering collaborative care (CoCM). At a high level, the new codes encourage greater BHI adoption by expanding provider types that can bill for BHI and broadening the activities that are incorporated into the billing codes. The impact of these changes should improve both provider and patient well-being as BHI proliferates and technology streamlines and supports BHI delivery. Private health plans that incorporate these codes will also encourage BHI among their provider partners, which will help lower costs. In this post we’ll explain what the proposed CPT codes are and their impact on behavioral health care.

GBHI1 – Licensed Independent Social Workers & Clinical Psychologists Can Bill for BHI

In a significant workflow change, the GBHI1 code allows licensed independent social workers and clinical psychologists to bill for BHI. Previously, as an incident-to code, this billing responsibility fell solely on physicians. By expanding who can bill for BHI, the AMA hopes to increase adoption of integrated behavioral health services.

The proposed reimbursement for GBHI1 is $41 nationally in a non-facility environment and is billable monthly, like 99484. The billing requirements also mirror 99484, which are outlined in this document.

The coding change should eliminate some of the burden on physicians who suffer from high rates of burnout and may find the added responsibilities of BHI overwhelming. National studies indicate that 50% of physicians suffer from burnout, which is significantly higher than the general population. Improving satisfaction among physicians by alleviating some of their workload will be critical in increasing the prevalence of integrated care.

It’s important to note, though, that although physicians will no longer be solely responsible for billing for behavioral health integration services, a team-based approach is essential to developing and implementing a patient’s care plan. To deliver the most effective care, care teams must take a holistic approach that incorporates both physical and mental well-being. Care teams should be mindful that this new workflow doesn’t eliminate the physician’s involvement in integrated care.

989X6 – Providers Can Bill for Remote Monitoring of Therapeutic CBT

The code 989X6 represents a significant shift to reimburse remote monitoring for behavioral health conditions. Once introduced, the code will drive greater adoption of technology-enabled mental health services within behavioral health and allow providers to bill for care in between appointments.

CMS has not determined what specific services and technologies 989X6 will cover, and is seeking comments on the billing code requirements until September 6. Regional Medicare Administrative Contractors (MACs) will determine the rates for 989X6, and it’s expected the ‘X’ in the code will be replaced by an official number in November.

Like GBHI1, experts anticipate 989X6 will have a positive impact on provider satisfaction. Instead of billing primarily on the number of patients a physician sees, they will be incentivized to deliver remote care and services. This should help reduce burnout as more patients are treated remotely and more preventative measures are implemented through monitoring technologies. Patients who can receive treatment and support remotely will also enjoy greater convenience and access as these services become more widely available.

New Codes Emphasize Importance of BHI and Quadruple Aims

As CMS rolls out the new billing codes, private insurances will likely follow suit as they have for codes like 99484 and 99492-94. The widespread adoption of the behavioral health care management codes will not only increase BHI but also help providers achieve the Quadruple Aims—a framework meant to optimize health system performance by enhancing patient satisfaction, reducing costs, improving outcomes, and increasing care team well-being.

BHI has been proven through multiple trials to reduce costs and improve patient outcomes, and if these codes succeed in increasing BHI adoption, they will help providers achieve both aims. In particular, the new CPT codes seem to focus on alleviating the burden placed on providers and improving patient access and satisfaction, arguably two aspects of the Quadruple Aims that have been the most difficult to achieve. Regardless of the final coding requirements announced later this year, it’s clear that BHI remains a cornerstone of CMS’s behavioral health approach and an important vehicle for achieving the Quadruple Aims.

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