Integrated medical and behavioral health care services
In our ongoing efforts to encourage medical and behavioral health integration, Anthem continues to promote early identification and intervention of behavioral health issues through primary care. Anthem currently reimburses for screening and assessment for behavioral health and substance use through billing the following codes:
- G0396/99408 – Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes
- G0397/99409 – Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention, greater than 30 minutes
- G0442 – Annual alcohol misuse screening, 15 minutes ≤ G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- G0443 – Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- G0444 – Annual depression screening, 15 minutes
Anthem also supports behavioral counseling for specific chronic conditions while in the primary care office. These services include:
- G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, 15 minutes
- G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
- G0473 – Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
In addition, Anthem reimburses for the psychiatric collaborative care codes; procedure codes 99492, 99493, 99494 are used to report these services. These codes are reportable by primary care providers for their collaboration with a qualified behavioral health provider, such as a psychiatrist, licensed clinical social worker, etc.
Care is directed by the primary care team and includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate. The psychiatric consultant provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.
These codes are intended to represent the care and management for patients with behavioral health conditions that often require extensive discussion, information-sharing, and planning between a primary care physician and a behavioral health specialist. The American Psychiatric Association (APA) has created a training program for primary care on the collaborative care model and the use of these codes. It can be found at APA Training Module.
October 2018 Anthem Provider Newsletter - Virginia