Back to Insights and Updates for ProvidersMay 2024

Reimbursement update: Behavioral Health Integration services

Harvard Pilgrim Health Care Commercial  |  Tufts Health Plan Commercial

We are expanding coverage for Behavioral Health Integration (BHI) services as follows, beginning May 1, 2024.

For Harvard Pilgrim Health Care and Tufts Health Plan Commercial members, we will provide coverage for code G0323 (Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month).

In addition, to align with current coverage for Harvard Pilgrim Health Care Commercial members, we will provide coverage of the following codes for Tufts Health Plan Commercial members, retroactively to Nov. 1, 2023: 99446-99449 (Interprofessional telephone/internet consultation). Point32Health will automatically reprocess any affected Tufts Health Plan Commercial claims for codes 99446-99449.

Prior authorization for BHI services is not required. More information about BHI services is available through the following Centers for Medicare and Medicaid Services resources: MLN Booklet on Behavioral Health Integration Services and Frequently Asked Questions about Billing for Behavioral Health Integration Services.

Broadly considered to be an effective approach to increasing access to mental health services, BHI is a type of care management that integrates behavioral health care with primary care. Common models for delivering BHI services include the Primary Care Behavioral Health (PCBH) Model and Psychiatric Collaborative/Collaborative Care Model (CoCM).

Editor’s note: This article was updated on 5/17/2024 to clarify effective date of coverage for codes 99446-99449 for Tufts Health Plan Commercial members.

Audrey Kleinberg,
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