Last updated October 16, 2023.
The Centers for Medicare & Medicaid Services (CMS) approved two new billing codes to increase adoption of behavioral health integration (BHI) and promote technology that provides remote behavioral health care and monitoring. These codes—G0323 and 989X6—went into effect at the beginning of 2023. The codes expand on existing BHI codes, and they could make a significant impact on the adoption of integrated care and help providers chart a more financially sustainable path toward integration.
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 new CPT codes are and their impact on behavioral health care.
G0323 – Licensed Independent Social Workers & Clinical Psychologists Can Bill for BHI
In a significant workflow change, the G0323 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. Further, non-licensed individuals can bill for BHI using G0323 under the supervision of an LCSW or clinical psychologist. By expanding who can bill for BHI, CMS hopes to increase adoption of integrated behavioral health services.
The reimbursement for G0323 is $41 nationally in a non-facility environment and is billable monthly, like General Behavioral Health Integration (General BHI) 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 stated that each Medicare Administrative Contractor (MAC) will develop its own pricing for CPT 989X6 until the agency “learn(s) more about the devices being used to furnish the service.” This means CMS is looking to see what technologies are being used to monitor CBT treatment, but has not set a national rate for reimbursement. Instead, reimbursement may vary by region.
The introduction of the 989X6 billing code marks an advancement, particularly in the realm of measurement-based care, the systematic use of patient-reported data to inform clinical decisions. By allowing healthcare providers to bill for remote monitoring services, the code facilitates enhanced data collection between appointments. This real-time data can include metrics related to outcomes from cognitive behavioral therapy (CBT), such as mood scores, activity levels, and sleep quality.
The availability of continuous monitoring enables healthcare providers to make timely interventions based on emerging trends or changes in a patient’s condition, thereby preventing the escalation of mental health issues. The code financially incentivizes providers to offer these remote monitoring services, making it more feasible for practices—especially smaller ones—to adopt this approach. Finally, CMS’s interest in learning about the technologies used for delivering these services signals an openness to innovation, potentially driving advancements in remote monitoring technologies tailored for behavioral health.
New Codes Emphasize Importance of Integrated and Measurement-Based Care
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 integrated behavioral health care 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.
Integrated care has been proven through multiple trials to reduce costs and improve patient outcomes, and if these codes succeed in increasing integrated care 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. In light of these new codes, it’s clear that integrated care remains a cornerstone of CMS’s behavioral health approach and an important vehicle for achieving the Quadruple Aims.
CPT codes are only part of building a financially sustainable integrated behavioral health program. Learn how to accomplish integration at scale in this in-depth white paper.