Submitting MHI Claims

All claims must be submitted with the most current and accurate procedure and diagnosis codes.

  • Procedure codes - Current Procedural Terminology (CPT ®), established by the American Medical Association (AMA)
  • Diagnosis codes - International Classification of diseases - Revision 10 (ICD-10), established by the World Health Organization

When services with behavioral health providers occur in collaboration with medical services, and all providers are employed by the clinic, there may be situations when it is appropriate to bill using "Incident-to" guidelines. Please refer to Coding and Reimbursement Policy #3, "Incident to Physician's Professional Services" for details.

An overview of the applicable collaborative care model codes (CPT 99492, 99493, 99494) appears below. For specific information on payment rates (fee schedule) for these codes, contact Provider Development at 800-538-5054.

Initial psych care management. First 70 minutes in the first calendar month of behavioral health care manager activities. Required elements include:

  • Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional
  • Initial assessment, including administering validated rating scales, and individualized treatment plan development
  • Psychiatric consultant review with plan modifications if recommended

Subsequent psychiatric care management. First 60 minutes in a subsequent month of behavioral health care manager activities. Required elements include:

  • Tracking patient follow-up and progress using the registry, along with appropriate documentation
  • Participation in weekly caseload psychiatric consultation

Initial/subsequent psych care management. Each additional 30 minutes in a calendar month of behavioral health care manager activities (list separately in addition to code for primary procedure).