How does BHI (Behavioral Health Integration) help payers and providers cut the total cost of care?

Behavioral Health Integration (BHI), which means combining mental health care with primary care, is becoming a key way to improve patient outcomes and lower healthcare costs overall. BHI is a chance for both payers and providers to meet patients’ behavioral health needs early on and avoid costly care later on. The Centers for Medicare & Medicaid Services (CMS) are actively pursuing a multi-pronged approach to broaden access to behavioral health services, a key component of their value-based care programs. Healthcare organizations can improve patient care and achieve substantial cost savings by utilizing CMS reimbursement models such as the Psychiatric Collaborative Care Model (CoCM). This guide talks about how adding behavioral health can lower the overall cost of care. It focuses on Medicare’s BHI programs, CoCM billing codes (CPT 99492, 99493, 99494, and G2214), and the financial return on investment (ROI) of adding BHI.

What does it mean to integrate behavioral health (BHI)?

BHI means combining behavioral health services, like mental health care for depression, anxiety, or substance use, with regular medical care. In practice, this often means including a behavioral health care manager and a psychiatric consultant in the primary care team. This allows for proactive management of patients’ mental health needs. Rather than isolated approaches, primary care providers, care managers, and mental health specialists work together, crafting a comprehensive care plan that addresses the individual as a whole. Many people agree that this coordinated approach works well to improve patient outcomes. It makes it possible to detect and treat behavioral health problems early on, which can improve savings by stopping expensive crises or hospital stays from happening later.

For instance, untreated depression or anxiety can exacerbate long-term physical problems, leading to increased overall costs. A recent study revealed that individuals grappling with chronic illnesses, alongside behavioral health issues, face annual healthcare expenses roughly $20,000 higher than those without such conditions. BHI tackles the issue by integrating mental and physical health care. Patients in primary care get mental health screenings, counseling, and help with their medications, and psychiatrists can help when needed. The approach has led to better access to mental health care (less stigma and shorter wait times) and better management of other health problems that go along with mental health issues.

Medicare’s Psychiatric Collaborative Care Model (CoCM)

Medicare has been a strong supporter of BHI through the evidence-based Psychiatric Collaborative Care Model. CoCM represents a particular flavor of behavioral health integration. It hinges on a collaborative model within a primary care setting. This means a primary care provider, the one responsible for treating or billing, teams up with a behavioral health care manager—frequently a nurse, social worker, or counselor—and a psychiatric consultant, who could be a psychiatrist or a psychiatric nurse practitioner. Together, they coordinate the patient’s care. This model is meant for patients whose behavioral problems aren’t getting better with regular care. CoCM has some important parts, such as using validated rating scales (like the PHQ-9 for depression) on a regular basis to keep track of progress, having systematic case reviews with the psychiatric consultant, and increasing the intensity of care if patients aren’t getting better.

CoCM has a long history of making things better. Research shows that this method can double the effectiveness of treatments for conditions like late-life depression, compared to standard care, while also leading to significant cost savings. Studies indicate that the collaborative care model can reduce long-term healthcare costs, with an estimated savings of up to $6 for every amount spent. These savings come from fewer trips to the emergency room, fewer hospital stays, and better management of chronic conditions that are affected by mental health. It’s not surprising that CMS and many commercial payers have adopted CoCM as a way to lower the overall cost of care by improving behavioral health management.

BHI billing CPT codes 99492, 99493, 99494, and G2214

The Physician Fee Schedule added specific billing codes for BHI services, especially CoCM, to help pay for Behavioral Health Integration. Using these codes correctly allows healthcare providers to be paid for the care management and psychiatric consultation services they offer in integrated care settings. CPT 99492, 99493, 99494, and the HCPCS add-on code G2214 (for Medicare) are the main CoCM codes. Here’s a list of what each code means:

• CPT 99492—Initial CoCM Month: The above code includes the first month of psychiatric collaborative care management, which includes the first 70 minutes of the behavioral health care manager’s time in that month. This usually includes an initial evaluation of the patient, making a care plan, reaching out to the patient and their family, and talking to the psychiatric consultant. This code is only charged once for each patient, at the start of CoCM treatment.
• CPT 99493 – Subsequent CoCM Months: Covers each month of collaborative care management after the first one, for the first 60 minutes of care manager activities in that month. During these months, the care manager actively monitors the patient’s symptoms, ensures that any treatment modifications are coordinated with the psychiatric consultant, and updates the care plan. After the first month, ongoing management is billed under code 99493.
• CPT 99494—Additional CoCM Time: This number is an extra code for any extra 30-minute blocks of time that a collaborative care manager spends with a patient beyond the base codes listed above. If a patient’s needs require more intensive engagement in a month—for example, an extra 30 minutes beyond the initial 60 in a subsequent month—the provider can bill 99494 in addition to 99492 or 99493 for that month. If you spend more than one 30-minute period, you can bill for more than one unit of 99494.
• HCPCS G2214– CoCM Partial Service (30 min): CMS added G2214 in 2021 to be used when the care manager’s time for CoCM services in a month is less than the full 99492 or 99493 time requirements but is at least 30 minutes. In other words, if the patient only receives collaborative care for a shorter amount of time in a month (like 30–39 minutes of care manager time instead of the full 60), G2214 can be used to bill for that work. This code makes sure that even “off-months” or months with less intense CoCM can be paid for as long as at least 30 minutes of collaborative care management is given.

Each month, these codes are billed for each member and require proof of the time spent and services provided, like patient contacts, care plan reviews, and consultations. CMS clearly directs providers to utilize CPT codes 99492, 99493, 99494, and G2214 for monthly CoCM services, citing the positive impact on patient outcomes as a key reason for this recommendation. It’s important to remember that general BHI (not including psychiatric CoCM) has its own CPT code (99484 for 20 minutes of behavioral health care management). CMS introduced HCPCS G0323 in 2023, enabling clinical psychologists and licensed social workers to bill BHI services under supervision. This expansion was a recent policy change meant to encourage more non-physician practitioners involved in BHI programs. It indicates that CMS is committed to making behavioral care easier to get.

Compliance tips for Providers: Providers should make sure they have the patient’s permission to sign up for BHI services and that they are not billing for other care management codes, like chronic care management, for the same patient at the same time without separate time documentation. Medicare needs clear records of the time spent on BHI activities and clinical activities (like assessment results, care plan updates, consultations, and so on) every month. A practice can make more money from this work and improve patient care by billing and documenting it correctly.

The financial return on investment (ROI) of BHI is that it saves money for both payers and providers.

BHI has the potential to lower overall healthcare costs and improve quality, which is beneficial for both payers and providers. This makes it a strong argument. BHI can lower the costs of things like emergency room visits, hospital stays, and unnecessary specialist care by treating behavioral health problems in primary care and stopping them from getting worse. Both real-world applications and research studies have indicated that there are big savings in costs:

• Fewer emergency room visits and hospital stays: Integrated behavioral health programs always report fewer visits to the emergency room and hospital stays. The University of Rochester Medical Center, for example, integrated Behavioral Health Integration (BHI) into its primary care clinics. Following this, they observed a 14.2% reduction in emergency department visits for all causes. They also saw that their patients were spending less time in the hospital and less money on care overall as the BHI program started. Another program showed that better behavioral care led to a 12.8% drop in hospital admissions and an 82% drop in ER visits for patients with serious mental illness. This instance shows how meeting behavioral needs can keep people from having to go to the hospital.
• Less spending overall and a high return on investment: BHI programs often pay for themselves many times over because they don’t use expensive treatments. A study by the Michigan Collaborative Care team found that the CoCM model led to a reduction in long-term healthcare costs, with a return of about $6 for every $1 spent. Similarly, when an employer offered a behavioral health integration benefit, medical claims costs decreased by $190 for every $100 spent. This resulted in a 90% return on investment in the first year. The landmark IMPACT trial for depression in older adults showed that collaborative care not only helped people with depression, but it also saved an average of more than $3,000 per patient in total healthcare costs within a year, even though the intervention only cost about $50. These savings come from things like better adherence to medication, fewer complications of chronic illnesses, and a lower need for inpatient psychiatric care.
• Better management of chronic diseases: Untreated behavioral health problems can make it harder to manage chronic diseases like diabetes, high blood pressure, and heart disease. BHI offers a way out. Patients who manage their mental health along with their physical health tend to be more involved in their care plans and achieve better control of their chronic conditions. Integrating mental health services into chronic care, for example, led to more patients seeing behavioral health providers for therapy and support. These changes reduced the workload of primary care doctors and resulted in a 12% decrease in primary care visits, while also improving patients’ depression and anxiety symptoms. Better mental health means better self-care for long-term conditions, which lowers the costs of complications in the long run. Because of this, healthcare payers not only save money on acute care, but they also see better chronic care quality metrics.
• Avoidable Cost Reductions for Payers: Health plans that address the behavioral health needs of their members can save a lot of money. For example, a care management program using artificial intelligence, which focused on members with unmet behavioral health needs, reported a 43% reduction in avoidable healthcare costs. This included a 32% decrease in emergency room costs and a 62% reduction in inpatient care costs after these members received integrated coaching and treatment. From the perspective of a payer, BHI can lower the overall medical loss ratio by stopping high-cost events from happening. Also, healthier members with managed behavioral conditions are happier and may leave less often, which is another financial benefit for insurers.

For providers, BHI has many different ways to pay off. First, Medicare and other insurance companies pay for BHI services, using the codes mentioned earlier. This creates a new source of income for healthcare practices that use collaborative care. A bustling primary care clinic has the potential to see substantial monthly earnings by overseeing a patient panel through the Collaborative Care Model, and the patients benefit from improved care in the process. Some family practices have calculated the profit margins for CoCM programs. They found that, even after paying a care manager’s salary, the reimbursements can be profitable with a reasonable number of patients, especially when billing for multiple 99494 add-ons for more complex cases. Second, effective BHI can make providers happier and help them work better. For example, primary care doctors spend less time on unmanaged mental health issues during visits because a dedicated team member is taking care of those issues between visits. These changes can help people avoid burnout and make the clinic run more smoothly, which can save money in the long run (for example, by keeping staff and boosting productivity).

The financial incentive for payers: better integrated care lowers the cost of healthcare and fits with the goals of value-based care. Numerous Medicare Advantage plans and Medicaid programs are currently reimbursing for CoCM codes or integrating behavioral health specialists within primary care settings, with the expectation of achieving overall cost savings. The Center for Medicare and Medicaid Services (CMS) Innovation Center has also supported behavioral health integration in models like Accountable Care Organizations (ACOs). This trend is based on the understanding that untreated depression or substance use problems increase healthcare costs for people with chronic illnesses. Payers can expect to save more on medical costs than they spend on care management when they invest in BHI (through reimbursement or grants). In other words, paying for a monthly collaborative care management fee of about $100 could save the insurance company hundreds or even thousands of amount by keeping people out of the hospital.

New CMS policies and programs that help BHI

CMS has been introducing changes to its policies to encourage the integration of behavioral health because it knows how it will affect costs and results. There have been a few changes lately, such as:

• New BHI Codes: CMS added HCPCS G0323 in 2023 to make it possible for more people to provide BHI services under the general BHI code criteria. This lets licensed clinical social workers and clinical psychologists take charge of BHI care for Medicare patients (billing under their own NPI in some cases), which makes it easier for people in areas where there aren’t enough primary care doctors to get the care they need. CMS also made new HCPCS codes in 2024 for services like monthly care planning for mental health problems and started paying for some digital behavioral therapy services. All of this was done to make more types of behavioral care eligible for reimbursement in integrative settings.
• FQHCs/RHCs Billing Flexibility: In the past, Rural Health Clinics and Federally Qualified Health Centers used a bundled code (G0511) for care management, which included BHI. Starting January 1, 2025, CMS will allow Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to charge for each visit using the regular Behavioral Health Integration (BHI) codes—specifically, 99484 for This change in policy is important because it encourages more specific use of BHI in these settings and makes sure that these safety-net providers get paid for every BHI service they provide. It shows how important it is to CMS to include mental health care in primary care for people who live in rural areas or don’t have access to it.
• Behavioral Health in Value-Based Models: CMS’s comprehensive plan for behavioral health is pushing integration beyond hourly billing. For example, the new ACO REACH and Medicare Primary Care First models include requirements or incentives for integrating behavioral health services. CMS is suggesting in the Physician Fee Schedule that behavioral health clinicians, such as therapists, could qualify for certain incentive payments. They are also suggesting the inclusion of mental health condition screening as a quality measure. The agency’s HHS Roadmap for Behavioral Health Integration, which came out in 2022, talks about plans to improve mental health parity, hire more people, and pay for training in collaborative care. All of these actions show payers and providers that integrating behavioral health is a long-term goal for improving quality and lowering costs.
• More Telebehavioral Health Coverage: During the COVID-19 pandemic, CMS and other payers greatly expanded coverage for telehealth, including tele-mental health services. This has made it easier to implement BHI, allowing care managers and psychiatric consultants to interact with patients and each other through virtual methods. CMS data indicated that the adoption of telehealth for substance use and other mental health services correlated with diminished overdose risks and enhanced follow-up, pointing to the importance of accessible behavioral healthcare. Medicare is extending or making permanent many of these telehealth flexibilities, which will contribute to the growth of BHI programs. For instance, Medicare will permit virtual psychiatric case consultations and patient follow-ups to contribute to BHI billing time.

To sum up, CMS is putting together payment and policy tools to make behavioral health integration possible and financially viable. Medicare and more and more private insurers see BHI as an important part of value-based care because it helps patients function better while lowering costs that could be avoided. Payers and providers who adopt these models early on are likely to see better patient health and cost savings.

Conclusion: Using BHI to lower costs and improve care

As healthcare moves from volume to value, integrating behavioral health is no longer an option; it is becoming necessary for both quality improvement and cost containment. BHI, especially through well-structured programs like the CoCM, is a proven way to lower the total cost of care. Patients get mental health support when they need it, providers get paid for managing care, and payers see fewer expensive emergencies and hospital stays.

Organizations can get healthier patients and a big return on investment (ROI) in the form of lower medical costs by putting money into behavioral health integration.

HealthArc’s Digital BHI Solutions: To make BHI work, providers and payers need the right tools to keep track of care and outcomes. HealthArc is leading the way with a unified digital health platform. This platform seamlessly integrates Remote Patient Monitoring (RPM), Chronic Care Management (CCM), Behavioral Health Integration (BHI), Transitional Care Management (TCM), and predictive analytics, all within a user-friendly system. Our platform streamlines care team workflows. We offer automated time tracking for BHI billing, secure online meetings for psychiatric reviews, and patient surveys such as the PHQ-9 and GAD-7. Plus, we provide real-time data to identify patients who might be at risk. HealthArc makes it easy for practices to start or improve their BHI programs quickly while still meeting CMS requirements. This is because it has EHR integration and customizable workflows. HealthArc’s solution helps providers save money, get better results in behavioral health and other areas, and get patients more involved by focusing on value-based care goals.
Are you ready to lower costs and improve patient care by integrating behavioral health? Set up a free demo to find out how HealthArc’s digital BHI solutions can help your business do well in this new era of care that is based on value and integration.

FAQs

Sources

• Centers for Medicare & Medicaid Services (CMS)—The CMS Behavioral Health Strategy. CMS is making it easier for people with Medicare, Medicaid, and private insurance to receive fair, high-quality behavioral health care.
• CMS Medicare Learning Network: Behavioral Health Integration Services Booklet (2025). Official instructions on BHI under Medicare, such as how to make a CoCM team and how to use CPT codes 99492, 99493, 99494, and G2214.
• The Providers Care Billing guide provides a complete overview of CoCM billing, including the use of codes 99492, 99493, 99494, and G2214. The guide explains the correct use of CoCM codes and the role of G2214 during partial service months.
• The American Hospital Association (AHA) published a case study in 2023 showing that integrating behavioral health care lowers the total cost of care. The case study highlights the implementation of the BHI program at the University of Rochester, which resulted in a 14.2% reduction in ED visits and overall costs following integration.
• The study, “Becker’s Payer Issues—How integrated insights lower ER costs and raise ROI,” was published in November 2024. It talks about a payer program that used integrated behavioral care management to save the insurer money by 32% in the ER and achieve a return on investment of more than 2:1.
• The Michigan Value Collaborative (2023) provides evidence for the effectiveness of the Collaborative Care Model. Reports say that collaborative care (CoCM) is very cost-effective, with studies showing that for every dollar spent on care integration, up to $6 can be saved.