Basics of CPT code 99484

General behavioral health integration care management services are provided by clinical staff, under the direct supervision of a qualified clinician, to a patient with a diagnosed behavioral health condition, including substance use issues, requiring care management services for a minimum of 20 minutes (either face-to-face or non-face-to-face) per calendar month. Specific elements of a treatment plan must be provided and documented for CPT code 99484, including an initial assessment or follow-up monitoring involving the use of validated rating scales; behavioral health care planning relating to the patient’s behavioral or mental health problems with revisions in cases where a patient is not responding to treatment or has a status change; organizing and coordinating all aspects of the patient’s mental health care such as therapy, medications, counseling, and/or psychiatric consultations; and continuing ongoing care in conjunction with a designated care team member.

The clinician does not need to provide a comprehensive assessment and treatment plan nor is the practice required to have all chronic care management functions. The patient may receive these services in any outpatient setting once certain criteria are established, namely that the clinician maintains a relationship with the patient and clinical staff and that the clinical staff be available to provide the patient with face-to-face services.

Description of CPT code 99484

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

• initial assessment or follow-up monitoring, including the use of applicable validated rating scales,
• behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes,
• facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and
• continuity of care with a designated member of the care team

Do not report CPT code 99484 in conjunction with 99492, 99493, 99494 in the same calendar month

E/M services, including care management services [99487, 99489, 99490, 99495, 99496], and psychiatric services [90785-90899] may be reported separately by the same physician or other qualified health care professional on the same day or during the same calendar month, but activities used to meet criteria for another reported service do not count toward meeting criteria for 99484

If the treating physician/QHP personally performs behavioral health care management activities and those activities are not used to meet the criteria for a separately reported code, his or her time may be counted toward the required behavioral health care management time to meet the elements of codes 99484, 99492, 99493, 99494.

Clinical Example (CPT code 99484)

Adult: A 50-year-old female established patient presents with complaints of fatigue and sleep disturbance following the recent loss of her spouse. The primary care physician diagnoses the patient with a behavioral health disorder and recommends that the patient receive behavioral health care management as part of the treatment.

Child/Adolescent: A 15-year-old child presents to the primary care physician with vague complaints of stomachaches, fatigue, excessive sleep, and atypically poor grades. The primary care physician diagnoses the patient with a behavioral health disorder and recommends that the patient receive behavioral health care management as part of the treatment plan.