What Is Behavioral Health Integration (BHI)? 99484 Explained

Updated October 2026. Written by Matteo Grassi, cofounder of HANA Health, trained in psychology.

Behavioral health integration (BHI) is a Medicare Part B monthly care management service for patients with a mental, behavioral or psychiatric condition. General BHI, billed with CPT 99484, needs at least 20 minutes of clinical staff time in a calendar month, covering assessment, care planning, treatment coordination and continuity of care, with documented patient consent (CMS, 2026).

Trained in psychology, I'd say 99484 only works if the monthly contact actually happens, so build the program around that.

Key facts

• CPT 99484 requires at least 20 minutes of clinical staff time per calendar month, directed by the billing practitioner (CMS MLN booklet, January 2026).
• The assumed billing practitioner time behind 99484 is 15 minutes a month (CMS MLN booklet, January 2026).
• Consent can be verbal, but it must be documented, and the patient must be told that cost sharing applies (CMS BHI FAQs).
• General BHI and the Collaborative Care Model (CoCM) codes can't be billed for the same patient in the same month (CMS BHI FAQs).
• Medicare BHI services grew from 24,033 in 2018 to 473,156 in 2024, and CoCM services from 55,082 to 284,062 (Blunt et al., JAMA Network Open, 2026).
• For 2026, CMS added three optional HCPCS add on codes, G0568, G0569 and G0570, for BHI and CoCM work layered onto advanced primary care management (CMS MLN Matters MM14315, December 2025).

What is behavioral health integration (BHI) in Medicare?

BHI is a monthly, time based care management service that puts behavioral health care inside the practice that already knows the patient. It's built for people with an identified mental, behavioral or psychiatric condition, including substance use disorder, who need an assessment, a care plan and interventions (CMS MLN booklet, 2026).

Medicare covers two kinds. Psychiatric CoCM uses a three person team: a billing practitioner, a behavioral health care manager and a psychiatric consultant. General BHI uses any other care model. Think of 99484 as the flexible option: no psychiatric consultant is required, and the clinical staff don't have to be available for face to face visits (CMS BHI FAQs).

The condition doesn't have to be on a fixed list. CMS says BHI can serve any mental, behavioral or psychiatric condition the billing practitioner is treating, and the diagnosis can be pre existing or made by the practitioner and refined over time.

BHI is also separate from chronic care management. CCM plans care for all health issues and includes preventive services, while BHI planning focuses on behavioral health and uses validated rating scales where they apply. If you want the CCM side of that comparison, start with our guide to chronic care management.

What does CPT 99484 require each month?

CPT 99484 requires at least 20 minutes of clinical staff time in a calendar month, directed by a physician or other qualified practitioner, and four service elements. Miss an element or the minutes, and you can't bill it (CMS MLN booklet, 2026).

The four required elements are:

1. An initial assessment or follow up monitoring, including validated rating scales where they apply.
2. Behavioral health care planning, including revising treatment for patients who aren't progressing or whose status changes.
3. Facilitating and coordinating treatment, such as psychotherapy, pharmacotherapy, counseling or psychiatric consultation.
4. Continuity of care with an appointed member of the care team.

A simple monthly workflow

1. Confirm the initiating visit and the consent are in the chart before the first minute counts.
2. Track clinical staff minutes only for work that fits the four elements.
3. Record the rating scale used and the date, plus any change to the plan.
4. Bill once the 20 minute threshold is met. CMS says you don't have to hold the claim until month end, though it expects you to keep furnishing services that month if they're medically necessary.

There's a sister code. HCPCS G0323 covers at least 20 minutes of clinical psychologist or clinical social worker time per month, and a psychiatric diagnostic evaluation (90791) serves as its initiating visit. For the dollar amount on 99484 in your locality, use the CMS Physician Fee Schedule lookup tool, because rates vary by geography.

Who can bill 99484, and who can do the work?

Physicians and non physician practitioners whose scope includes E/M services can bill BHI. That covers physicians of any specialty, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives (CMS MLN booklet, 2026).

The billing practitioner can deliver the service personally or use qualified clinical staff. Clinical staff include contractors who meet the qualifications for a CoCM behavioral health care manager or psychiatric consultant. CMS assigns general supervision to BHI services the practitioner doesn't personally perform, which means the practitioner doesn't need to be physically present.

Two cautions. General supervision alone doesn't create a qualifying relationship between the practitioner and the care team member. Staff are employees of the billing practitioner or work under contract with them. And CMS lets psychiatric consultants and other team members deliver certain services remotely, so a clinician working from home can still count.

If you're considering outside staff, the same incident to logic we cover in our post on outside staff and CCM is the right starting point. Check your MAC before you build a contracted model.

What consent and initiating visit does BHI need?

BHI needs advance patient consent and, for new patients or patients not seen in the prior year, an initiating visit with the billing practitioner (CMS BHI FAQs). Both have to be in place before you start counting time.

Consent has three parts. The patient gives permission for the practitioner to consult relevant specialists, including a psychiatric consultant. The practitioner tells the patient that cost sharing applies to face to face and non face to face services, even if a supplemental insurer covers it. And the consent is documented in the medical record. It can be verbal. A new consent is only needed if the patient changes billing practitioners.

Qualifying initiating visits include the annual wellness visit, the initial preventive physical exam, a comprehensive E/M visit, and the face to face visit in transitional care management. One detail trips people up: the practitioner has to discuss BHI with the patient at that visit. If they don't, the visit can't count as the initiating visit.

Our post on CCM consent and care plans covers a similar consent flow for a different code set, and the two can share one onboarding script.

How is general BHI different from CoCM?

General BHI is a lighter model with one time threshold and no required psychiatric consultant, while CoCM is a structured team model with a registry, weekly caseload review and higher time thresholds. The minutes below come from the CMS BHI coding summary (MLN booklet, 2026).

• 99484 (general BHI): at least 20 minutes of clinical staff time per month. Assumed billing practitioner time is 15 minutes.
• 99492 (CoCM, first month): at least 70 minutes of behavioral health care manager time. Assumed practitioner time is 30 minutes.
• 99493 (CoCM, later months): at least 60 minutes of care manager time. Assumed practitioner time is 26 minutes.
• 99494 (CoCM add on): each additional 30 minutes in a month, billed with 99492 or 99493.
• G2214 (CoCM, short month): 30 minutes of care manager time, for months when you don't reach the standard thresholds.

You pick one approach per patient per month. Over several months it can be appropriate to switch between general BHI and CoCM, as long as you don't report both in the same month.

Is it getting traction? Use is rising from a small base. A 2026 analysis of Medicare billing files found BHI services rose from 24,033 to 473,156 between 2018 and 2024, while CoCM services rose from 55,082 to 284,062. The authors note those totals are lower bounds because the data suppress small cells, and the study can't tell whether growth reflects more practices, higher intensity at existing ones, or a changing patient mix.

Can you bill BHI in the same month as CCM or APCM?

BHI can be billed in the same month as CCM if consent for both exists, every requirement for each service is met, and no time is counted twice (CMS BHI FAQs). CMS wrote that guidance years ago, so confirm it with your MAC before you build workflows around it.

The reasoning is that CCM and BHI are distinct services with overlapping patients. Cost sharing and consent apply to each service on its own, and only one practitioner can report CCM in a month. If a BHI code more specifically describes the work, CMS says to prefer it over CCM.

APCM works differently. For 2026, CMS finalized three optional add on codes, G0568, G0569 and G0570, billed when the same practitioner reports the APCM base code that month. CMS describes them as directly comparable to the existing CoCM and general BHI codes (MLN Matters MM14315, December 2025). The final rule summary doesn't spell out every staffing and documentation detail, so treat the add ons as new and read the rule text before you adopt them.

What this means for your practice

Start by finding the patients you're already managing who have a behavioral health condition and no structured monthly follow up. Those are your candidates for 99484, and the work is often already happening unbilled.

Next, make the compliance pieces boring and repeatable. Put the consent language in your onboarding script, build an initiating visit check into scheduling, and decide which rating scales you'll use. Then decide whether general BHI is your ceiling or a stepping stone to CoCM.

The hardest part is rarely the code. It's reaching patients every month, getting the rating scale completed and documenting the work. HANA handles patient outreach and consent calls for remote and care management programs, so your clinical staff spend their minutes on clinical work. You can see how it fits on our care coordination page.

Frequently asked questions

What is the difference between 99484 and G0323?

Both need at least 20 minutes a month. 99484 counts clinical staff time directed by the billing practitioner, while G0323 counts time from a clinical psychologist or clinical social worker, and it uses a psychiatric diagnostic evaluation as its initiating visit.

Does 99484 require a psychiatric consultant?

No. General BHI can use care models that don't involve a psychiatric consultant or behavioral health care manager, although those people may deliver the service if you have them.

Is written consent required for BHI?

No. CMS allows verbal consent, but you must document it in the medical record, and the patient has to hear that cost sharing applies. You only need a new consent if the patient changes billing practitioners.

Can a patient with only a substance use disorder get BHI?

Yes. CMS says BHI can serve any mental, behavioral or psychiatric condition the billing practitioner is treating, including substance use disorder.

Can clinical staff deliver BHI remotely?

Yes, for the services CMS allows. Psychiatric consultants and other care team members can deliver certain BHI services remotely, and general BHI doesn't require clinical staff to be available for face to face care.

Sources

1. Centers for Medicare & Medicaid Services, Medicare Learning Network. MLN909432, Behavioral Health Integration Services. January 2026.
2. Centers for Medicare & Medicaid Services. Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services.
3. Centers for Medicare & Medicaid Services, Medicare Learning Network. MM14315, Medicare Physician Fee Schedule Final Rule Summary: CY 2026. December 2025.
4. Blunt K, Johns K, McAlearney AS, Miller LE. Trends in Medicare Billing by Oncologists for Integrated Mental Health Care Services. JAMA Network Open, 2026.
5. Centers for Medicare & Medicaid Services. Search the Physician Fee Schedule. Lookup tool for locality rates.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you'd like to talk through how a behavioral health program could run in your practice, book a discovery call.