Uptake of Medicare Behavioral Health Integration Billing Codes in 2017 and 2018
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J Gen Intern Med DOI: 10.1007/s11606-020-06232-z © Society of General Internal Medicine 2020
INTRODUCTION
Reimbursement models have not historically supported the integration of mental health services into primary care.1 In January 2017, the Centers for Medicare & Medicaid Services introduced fee-for-service (FFS) Medicare Part B billing codes for Psychiatric Collaborative Care Management (CoCM) and General Behavioral Health Integration (BHI).2 CoCM enhances primary care through the addition of behavioral health care managers and psychiatric consultation whereas BHI supports various integration models and staffing configurations. Qualitative research has identified barriers to using the CoCM codes and a recent study based on a random sample of Medicare beneficiaries found that 0.1% of those with behavioral health conditions received services through either type of code in 2017 and 2018.3 We expanded on that study to examine the uptake of these codes among a different group of beneficiaries—those with behavioral health conditions attributed to primary care practices, as those with primary care providers are most likely to benefit from these codes. We also examined whether the types of diagnoses and providers differed between CoCM and BHI claims, and if claims were concentrated within practices and states.
METHODS
We conducted these analyses using data from the Comprehensive Primary Care Plus (CPC+) evaluation, which requires practices to integrate behavioral health care and allows them to use these billing codes among others. We analyzed calendar year 2017–2018 Medicare FFS data that included 7.2 million beneficiaries located in 38 states and DC who were attributed to either the 2888 primary care practices that began CPC+ in 2017 or the 6921 comparison primary care practices. (Peikes et al. (2019) describe patient attribution methods, which used a 2-year lookback period).4 Among these beneficiaries, 2.1 million (22% of Received February 3, 2020 Accepted September 10, 2020
CPC+ beneficiaries and 22% of comparison beneficiaries) had a behavioral health condition (mental health or substance use) defined as any claim with a primary behavioral health diagnosis or 1 inpatient or 2 outpatient/ambulatory claims with any behavioral health diagnosis during each analytic year. We conducted descriptive analyses of CoCM and BHI claims among beneficiaries with behavioral health conditions.
RESULTS Uptake. From 2017 to 2018, the number of CoCM and BHI claims and the proportion of beneficiaries represented by those claims increased but were less than 0.1% in both years (Table 1). Given the small number of claims using these codes and because CPC+ practices had not yet fully implemented integration during our analytic period, we did not compare CPC+ and comparison practices. Conditions. Almost all CoCM claims had a primary mental health diagnosis; major depressive disorder and anxiety disorder were most common. In contrast, 31% of BHI claims had a non-behavioral health primary diagnosis and the primary behavioral health diagno
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