What does Behavioral Health Integration pay in 2026?
| Code | What it covers | CY2026 national non-facility |
|---|---|---|
| 99484 | general BHI, 20 min / month (physician / NP-PA lane) | $57.45 |
| G0323 | BH care management (psychologist / LCSW / counselor / MFT lane) | $57.78 |
National averages from our verified CY2026 fee-schedule config (source: CMS Physician Fee Schedule). Actual payment varies by locality, payer, and site of service.
Who can bill it?
Two lanes: physicians and NP/PA/CNS practitioners bill 99484; behavioral-health clinicians — clinical psychologists, licensed clinical social workers, mental health counselors, and marriage & family therapists — bill G0323 under their own NPIs.
Care-management staff furnish the minutes under the billing clinician's direction in either lane.
One practitioner bills BHI for the patient in a given month — and the same practitioner can't bill BHI and CoCM for the same patient-month.
What are the minute thresholds?
- 20 minutes of BHI care-management time in the calendar month opens the base code — there is no add-on ladder in this family.
- A validated behavioral rating scale (PHQ-9, GAD-7, or similar) must be captured during the month.
- Minutes only count once — time claimed by psychotherapy or another billed service is excluded.
What has to be in place first?
- A validated rating scale this month
- BHI requires systematic assessment with a validated instrument each billed month. No scale on file, no claim — this is the gate practices most often fail.
- Consent and enrollment
- Documented consent (with the single-biller disclosure) and program enrollment before billing begins.
- The right code for the right clinician
- Physicians and NP/PAs bill 99484; psychologists, LCSWs, mental health counselors, and MFTs bill G0323 under their own NPIs. The two pay within about a dollar of each other in the office — CMS values G0323 by a direct crosswalk to 99484's work — so pick the code that matches your credential, not the one you think pays more.
- A complete claim identity
- Rendering NPI and practitioner type on file.
What gets claims denied?
- No scale, no claim
- A month of real behavioral care management with no validated rating scale captured is a month BHI cannot bill. Capture the scale as part of the monthly workflow, not as an afterthought.
- BHI and CoCM in the same month
- The same practitioner cannot bill both for the same patient-month — CoCM's codes already include the BHI work. Pick the model that matches the team you actually ran.
- Wrong lane for the clinician type
- A psychologist billing 99484 (an E/M-eligible code) instead of G0323 is a practitioner-type mismatch that denies.
- Confusing G0570 with standalone BHI
- G0570 is the APCM add-on version of general BHI — it bills only alongside an APCM bundle, never on its own.
- Assuming commercial parity
- G0323 is a Medicare-first code; commercial payers may not have loaded it. Expect CO-181-class denials where adoption hasn't happened.
- Billing the office rate from a facility
- The rates above are national non-facility (office) values. Both BHI codes pay meaningfully less in a facility setting — G0323 drops from about $57.78 to $37.74, and 99484 from about $57.45 to $38.75. Price a facility-furnished month on the facility value; billing the office rate from a facility overstates the claim.
What could this look like for your panel?
Estimates only, not billing advice. Actual Medicare reimbursement varies by region, payer, and year. Figures approximate CY2026 national non-facility averages from our verified fee-schedule config.
Frequently asked questions
- What is the difference between BHI and CoCM?
- BHI (99484/G0323) is general behavioral-health care management a single practice can run. CoCM (99492–99494) requires the full collaborative team — behavioral care manager, psychiatric consultant, weekly registry review — and pays substantially more for it.
- Can a therapist or LCSW bill BHI directly?
- Yes. Clinical psychologists and clinical social workers have billed G0323 — the BH-clinician version of general BHI — under their own NPIs since 2023. Since January 2024, mental health counselors (including LPCs) and marriage & family therapists can too: CMS rewrote the code's descriptor to count their time when the CAA 2023 made them Medicare-enrolled providers. All four bill it directly, no supervising physician required.
- What counts as a validated rating scale?
- A published, validated instrument appropriate to the condition — PHQ-9, GAD-7, and similar. It has to be administered during the billed month, every month.
- Can BHI and CCM be billed in the same month?
- Yes, by the same or different practitioners — they manage different problem lists. No minute can count toward both thresholds.
This page is general information, not billing, coding, or legal advice. Verify current requirements with the relevant payer before billing. Mallowa helps practices capture and document coordination time and generates claim-ready superbills; it does not submit claims or determine eligibility.