Arrangements with Payers

Most primary care settings begin their journey relying primarily on fee-for-service (FFS) payment models³—the traditional way providers are reimbursed by payers (including Medicaid, Medicare, and private insurers) for each specific service delivered. However, as the field of integrated behavioral health (IBH) continues to mature, more practices are finding that fee-for-service payments alone rarely cover the full cost of providing IBH care.^1–3

To address this gap, the arrangements between payers and providers are evolving. This evolution is driven by the Quadruple Aim, a framework designed to optimize health system performance.¹⁰ Payers are increasingly moving toward alternative payment models that provide primary care providers with incentives for care quality and coordination rather than just volume.¹¹

Shifts in Risk and Responsibility

Moving away from the traditional fee-for-service payment model requires a fundamental shift in the payer-provider dynamic. As a practice or system moves closer to global payment and capitation, the financial risk shifts from the payer to the provider. This progression requires a significantly higher level of provider integration, as care teams must synchronize clinical and behavioral data to manage costs effectively. Simultaneously, complexity and accountability increase as providers adopt sophisticated systems to track outcomes and manage the total cost of care. Ultimately, while global payments offer the highest degree of flexibility, they also place the maximum degree of risk on the provider.¹²

Primary care settings may find themselves moving along this continuum as new payment options for IBH care become available and as they develop greater capacity for risk-sharing. Progression along the continuum toward global payment/capitation is not one-size-fits-all—it depends on a primary care setting’s readiness for integrating behavioral health services, payer environment, and patient population. Understanding where your practice or system currently falls on this continuum—and identifying opportunities to braid in additional funding sources—is key to building a sustainable and adaptable financial strategy for implementing IBH.

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Fee-For-Service Payment Models

While the field is shifting toward value-based care, fee-for-service remains the dominant payment model in the United States. In this arrangement, payers reimburse providers based on standardized billing codes that describe the services provided. These include:

Current Procedural Terminology (CPT) codes, developed by the American Medical Association (AMA); and
Healthcare Common Procedure Coding System (HCPCS) codes, developed by the Centers for Medicare & Medicaid Services (CMS).

There are more than 50 CPT and HCPCS codes that are relevant to supporting patient behavioral health needs and implementing IBH services. (For more information about estimating potential revenue, determining eligible billing providers, and gaining practical context for code utilization, leverage resources from the National Council for Mental Wellbeing’s Center of Excellence for Integrated Health Solutions.)

These codes can be grouped into two levels of intensity based on the time, coordination, and care team roles required for the behavioral health services being provided.

Code Categories for Low Intensity Services

Billing codes for lower intensity services focus on prevention, screening, and brief interventions for behavioral health concerns. They are typically used prior to a formal diagnosis, do not require a large care team for implementation, and can be delivered independently by a behavioral health provider in a primary care setting. These code categories include:

Preventive Medicine
Behavior Change Interventions
Psychotherapy
Developmental Behavioral Screening
Health Behavior Assessment and Intervention

Code Categories for High Intensity Services

Billing codes for higher intensity services involve more sustained care management, interprofessional collaboration, and specific IBH care models. They typically involve more time, more coordination, and a defined care team, and often include systematic follow-up, communication across specialties, or the use of digital treatment tools. These code categories include:

Safety Planning and Crisis Care
Behavioral Health Interprofessional Consultation
General Behavioral Health Integration (BHI) Care Management
Digital Behavioral Health
Psychiatric Collaborative Care Management (CoCM)
Advanced Primary Care Management (APCM)

Payer Variability with Billing Codes and Reimbursement Rates

Understanding the relationship between these codes and specific payer policies is essential for maximizing reimbursement, as coverage and requirements vary significantly across the three main types of payers:

Medicare. Medicare billing codes and reimbursement rates are nationally standardized (see the Centers for Medicare & Medicaid’s CY 2026 Finalized Medicare Physician Fee Schedule and Code List). For a more comprehensive list of Medicare billing codes for behavioral health services and guidance for how to use them, see the AMA’s Behavioral Health Coding Resource (PDF – 209 KB).
Medicaid. Each state determines its own Medicaid billing codes and reimbursement rates, often based on Medicare’s structure. For more information about your state’s Medicaid policies, see the National Academy for State Health Policy’s Medicaid coverage resources and the Advancing States’ State Medicaid Integration Tracker.
Private Payers: An increasing number of private, commercial insurance plans are reimbursing providers for Medicare-established General BHI and CoCM billing codes,¹³ though payment levels and billing rules vary by insurer, plan, and provider contract (e.g., in- vs. out-of-network).¹ Learn more about the behavioral health payment policies for the largest private payers and how much providers are paid for services by commercial payers relative to Medicare.

Securing consistent reimbursement for IBH may require proactive advocacy and negotiation, particularly with state Medicaid agencies and commercial insurers. If a payer does not currently cover the behavioral health billing codes you need in their standard fee schedule, you can negotiate with them to include those codes or inquire about alternative payment arrangements.

Optimizing Behavioral Health Billing Code Usage

The primary objective with fee-for-service payment models is to optimize revenue capture to cover as much of the cost of IBH care functions as possible. Despite being established in 2017, the General BHI and CoCM billing codes remain significantly underutilized—only an estimated 13.6% of integrated practices use them.^3,14–16 While fee-for-service payment alone rarely covers the full costs of behavioral health integration, understanding and accurately using these codes can generate steady revenue for your primary care setting and lay the foundation for transitioning into alternative payment models.¹⁷

The billing codes included below represent a sample of Medicare billing codes for high-intensity behavioral health services. Each code has specific requirements regarding the service performed, the time spent, and the eligible providers. Which codes you ultimately choose will depend on your care model, patient population needs, and payer arrangements.

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Using Billing Codes for Safety Planning and Crisis Care

Safety-planning codes support suicide and overdose prevention and post-crisis care in primary care settings for patients at risk.

G0560: For safety planning interventions for patients with suicidal ideation or overdose risk. It is billed in 20-minute increments when performed by the billing practitioner.
G0544: For post-crisis follow-up care, covering up to four telephonic follow-up calls per month after an emergency department discharge.

Learn more about using billing codes for safety planning and crisis care (PDF – 3 MB).

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Using Billing Codes for Behavioral Health Interprofessional Consultation Services

These behavioral health interprofessional consultation services codes allow specialists who are not eligible to bill for evaluation and management visits—such as clinical psychologists, clinical social workers, marriage and family therapists, and mental health counselors—to bill for their consultation time.

G0546 - G0549: For assessments of varying lengths (5-10 minutes, 11-20 minutes, etc.).
G0550: For an assessment with a written report.
G0551: For a referral service.

Learn more about using billing codes for behavioral health interprofessional consultation services (PDF – 3 MB).

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Using Billing Codes for General Behavioral Health Integration Care Management Services

General Behavioral Health Integration (BHI) codes are specifically designed for IBH services provided in primary care settings. They allow for reimbursement for the time spent on initial and systematic assessment, care planning, facilitating and coordinating treatment, and ensuring continuity of care for a patient's behavioral health needs.

99484: For care management services for behavioral health conditions that include at least 20 minutes of clinical staff time per calendar month.
G0323: For general BHI services performed by a clinical psychologist (CP) or clinical social worker (CSW), accounting for at least 20 minutes of their time per calendar month. The service is initiated with a psychiatric diagnostic evaluation (CPT code 90791).

Learn more about using billing codes for general behavioral health integration care management services (PDF – 3 MB).

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Using Billing Codes for Digital Behavioral Health

With the growing use of telehealth technologies and mobile applications to diagnose, manage, and treat behavioral conditions, new codes have been established to cover the cost of digital mental health treatment devices approved by the Food and Drug Administration and the professional time required to manage patient care using those devices.

G0552: For the supply of a digital mental health treatment device, initial education, and onboarding per treatment course that supports a behavioral therapy plan.
G0553: For the first 20 minutes per month of treatment management.
G0554: For each additional 20 minutes per month of device-related management.

Learn more about using billing codes for digital behavioral health (PDF – 3 MB).

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Using Billing Codes for Psychiatric Collaborative Care Management Services

The Collaborative Care Model (CoCM) is a specific IBH model delivered by a team of three: a treating practitioner, a behavioral health care manager, and a psychiatric consultant. This model is supported by its own set of codes.

99492: For the first calendar month of CoCM services, requiring at least 70 minutes of a behavioral health care manager's time.
99493: For subsequent months of CoCM services, requiring at least 60 minutes of a behavioral health care manager's time.
99494: For each additional 30 minutes of behavioral health care manager activities in any month.
G2214: For initial or subsequent CoCM services, when the behavioral health care manager provides at least 30 minutes of service per month, in consultation with a psychiatric consultant.

Learn more about using billing codes for CoCM services (PDF – 3 MB).

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Using Billing Codes for Advanced Primary Care Management Services

Advanced Primary Care Management (APCM) codes, such as those related to chronic care management, can be used to bill for the time spent coordinating care for patients with complex conditions, including those with co-occurring physical and behavioral health needs. APCM codes are a bundle of services. The activities that support IBH—such as systematic needs assessments (which include psychosocial needs), care plan development, and care coordination—are a core part of the requirements for these codes.

G0556: Comprehensive care management, including the development of a care plan for a patient with a single high-risk chronic condition.
G0557: Comprehensive care management, including the development of a care plan for a patient with multiple chronic conditions.
G0558: Advanced primary care services, including comprehensive care management and coordination for patients with multiple chronic conditions.

Three codes can be used as add-on services for Advanced Primary Care Management (APCM):

G0568: Initial psychiatric collaborative care model (CoCM) services (first calendar month), comparable to CPT 99492.
G0569: Subsequent psychiatric collaborative care model (CoCM) services (subsequent months), comparable to CPT 99493.
G0570: General behavioral health integration (BHI) services, comparable to CPT 99484.

Learn more about using billing codes for APCM services.

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Alternative Payment Models

Alternative payment models are specialized payment frameworks that move away from traditional fee-for-service by creating new ways for payers to reimburse providers. These models serve as the financial vehicle for value-based care—a clinical strategy focused on the quality of care provided rather than the quantity of services. Value-based payment offers a promising alternative to fee-for-service payment by linking payer reimbursement to quality, outcomes, and efficiency rather than volume. Payers and providers enter into agreements that reward primary care settings for achieving measurable improvements—such as behavioral health screening and follow-up, chronic disease management, patient engagement and access, and preventive care completion.

This shift allows primary care settings to sustain team-based, collaborative care, invest in care coordination, and address behavioral health needs proactively—activities that are typically under- or uncompensated in fee-for-service payment models. Performance is often measured using established quality metrics, such as the Healthcare Effectiveness Data and Information Set (HEDIS), which provides a standardized way to track behavioral health outcomes such as depression screening and follow-up care. Alternative payment models have been shown to improve process-of-care outcomes, such as screening and treatment initiation, lower spending, and reduce utilization. While alternative payment models vary significantly, they most commonly target adults and populations with substance use disorders. Medicaid and public funding remain the primary drivers of these alternative payment model initiatives.¹⁸

Implementation Considerations

Successfully implementing value-based payment requires close alignment with payer-specific reporting requirements. Many primary care settings face challenges with data availability, data analysis capabilities, health information technology infrastructure, the need to reconcile different quality and cost metrics across multiple payer contracts, and the task of attributing revenue from value-based payments to specific providers, especially behavioral health providers.^12,18,19 Because of these complexities, most payers still require fee-for-service billing codes to be submitted to document services and calculate value-based payment.²⁰

The timing and structure of value-based payments vary significantly depending on the arrangement’s level of risk. Revenue may be received as prospective fixed payments, retrospective bonuses, or withheld and paid out after an end-of-year reconciliation, or as adjustments to future fee-for-service rates based on the previous year's performance. Payment may be adjusted for other factors, including the relative health of the patient population, such as geography, care setting, and health-related social needs.

Value-Based Payment Arrangements

The most common value-based payment arrangements for behavioral health integration include:

Pay-for-Performance Incentives
Bundled Payments
Shared Savings
Shared Risk
Global Payment/Capitation

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Pay-for-Performance Incentives

Pay-for-performance incentives reward providers for meeting benchmarks set by the payer for specific quality or efficiency metrics, including clinical outcomes, patient safety, patient satisfaction, adherence to evidence-based guidelines, and cost-effectiveness. The incentives are often an extra layer of payment on top of fee-for-service reimbursement or prospective capitated payment.³ Providers who meet or exceed the benchmarks receive a bonus. IBH services can contribute directly to achieving these benchmarks and collecting financial incentives.

Learn more about pay-for-performance incentives for IBH services.

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Bundled Payments

In this arrangement, the payer groups together all services related to a specific condition or episode of care into a single payment. Instead of paying separately for each individual test, procedure, or visit, a lump sum is allocated to cover the entire episode of care, which can span from the initial treatment through recovery. When the total cost of care falls below the bundled payment, providers share in the savings.

While specialists often perform well in bundled payment arrangements, behavioral health integration poses a challenge. Several behavioral health conditions lack a single triggering event like a surgery or hospital admission (to mark the start of a bundle) and a defined recovery period (to mark the end of the bundle), which makes it difficult for payers to establish predictable cost targets.¹²

Learn more about bundled payments for IBH services.

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Shared Savings

In a shared savings (or one-sided risk) arrangement, the payer establishes a benchmark or target budget for a specific patient population. To earn a payout, providers must not only maintain actual costs below this benchmark but also meet defined quality benchmarks to prove that cost-cutting did not compromise care. When both the financial and quality targets are achieved, the payer shares a percentage of the resulting savings back with the provider.

While this arrangement offers an entry point into value-based payment with no financial downside to the provider, there is a risk that behavioral health providers aren’t credited for the savings their interventions generate.¹² Establishing internal agreements can ensure a fair portion of the revenue is distributed to the behavioral health providers on integrated care teams.

Learn more about shared savings arrangements for IBH services (PDF – 580 KB).

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Shared Risk

In a shared (or two-sided) risk arrangement, the provider and the payer share in both the savings and losses. If the cost of care exceeds the payer’s budget, the provider may be required to pay back a portion of the overage. This model requires high levels of provider integration and advanced data analytics to avoid financial penalties.

Learn more about shared risk arrangements (PDF – 636 KB).

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Global Payment/Capitation

In a capitation or global payment arrangement, the payer provides a fixed amount of money per patient enrolled in their care over a specific period (usually per-member-per-month), regardless of how many times that patient seeks care or the types of services they utilize. The provider assumes full responsibility for the patient's care within that budget. When the total cost of care or cost of primary care services falls below the total amount of the capitated payments received, the provider keeps the savings.

In some capitation and global payment arrangements, providers receive a per-member-per-month payment while also receiving fee-for-service payments for visits, pay-for-performance incentives for achieving specific care quality or cost benchmarks, or bundled payments for a specific episode of care or a specific chronic condition.³

Learn more about using capitated payments for IBH services (PDF – 236 KB).

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NIAC Note: Test the Waters

If you are considering a new billing code but your practice or system is risk-averse, remember that you don’t have to commit all at once—you can start small to build confidence. Consider conducting shadow billing during a grant-funded period or piloting a specific code with a small subset of patients or a single payer to see how the claims process. This low-risk approach allows you to test the reality of reimbursement and iron out any documentation kinks before rolling the code out across your entire practice or system, ensuring you have the proof of concept you or your leadership needs to move forward.

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NIAC Note: Master the Basics

You don’t—and shouldn't—try to implement every financing strategy at once. Start with the basics. Focus on mastering the nuts and bolts of fee-for-service billing codes first to build a stable financial foundation and a reliable record of your services. Once your coding and documentation are consistent and reliable, you can leverage that data to move confidently toward alternative payment models, such as performance incentives, shared savings, capitation, or global budgets.

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NIAC Note: Anticipate the Learning Curve

Transitioning to alternative payment models requires active advocacy and intentional relationship building with your payers, so it is important to be realistic about the timeline. Meeting with care coordination and population health teams takes time, and you’ll need that time to align your internal workflows with the specific cost and outcomes metrics payers are tracking. This isn’t just a simple billing update; it’s a fundamental relationship change that requires moving away from transactional interactions and toward a collaborative partnership in which you consistently demonstrate how your integrated behavioral health model drives performance.

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1. Miller BF, Ross KM, Davis MM, Melek SP, Kathol R, Gordon P. Payment Reform in the Patient-Centered Medical Home: Enabling and Sustaining Integrated Behavioral Health Care. Am Psychol. 2017 Jan;72(1):55-68. doi:10.1037/a0040448 PubMed PMID: 28068138; PubMed Central PMCID: PMC7324070.

2. Grazier KL, Smiley ML, Bondalapati KS. Overcoming Barriers to Integrating Behavioral Health and Primary Care Services. J Prim Care Community Health. 2016 Oct 1;7(4):242-248. doi:10.1177/2150131916656455

3. Ma KPK, Mollis BL, Rolfes J, Au M, Crocker A, Scholle SH, et al. Payment strategies for behavioral health integration in hospital-affiliated and non-hospital-affiliated primary care practices. Transl Behav Med. 2022 Jul 26;12(8):878-883. doi:10.1093/tbm/ibac053 PubMed PMID: 35880768; PubMed Central PMCID: PMC9385119.

4. By. UNC Family Medicine Launches Primary Care Behavioral Health Collaborative at East Pittsboro, Advancing Whole-Person Care. Newsroom [Internet]. 2026 Jan 22 [cited 2026 Feb 18]. Available from: https://news.unchealthcare.org/2026/01/unc-family-medicine-launches-primary-care-behavioral-health-collaborative-at-east-pittsboro-advancing-whole-person-care/

5. Yabuki family donates $20 million to transform response to pediatric mental and behavioral health crisis [Internet]. [cited 2026 Feb 18]. Available from: https://childrenswi.org/at-every-turn/stories/2021/07/yabuki-donates-20-million-to-address-mental-health-crisis

6. Anschutz Foundation Supports Youth Mental Health with Generous Gift [Internet]. [cited 2026 Feb 18]. Available from: https://www.childrenscolorado.org/about/news/2025/september-2025/transformational-gift-for-mental-health-care/

7. Healing Hands Health - Bristol, TN [Internet]. [cited 2026 Feb 23]. Food City Presents $100,000 Check to Healing Hands Health in Support of Capital Campaign. Available from: https://www.healinghandshealth.org/press-releases/food-city-presents-100000-check-to-healing-hands-health-in-support-of-capital-campaign

8. Capital Campaign. Community Health Center of NRV [Internet]. [cited 2026 Feb 23]. Available from: https://chcnrv.org/capital-campaign/

9. St. John’s Health [Internet]. [cited 2026 Feb 18]. Capital Additions & Upgrades | St. John’s Health Foundation. Available from: https://www.stjohns.health/foundation/campaigns/behavioral-health-endowment/

10. Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med. 2014 Nov;12(6):573-576. doi:10.1370/afm.1713 PubMed PMID: 25384822; PubMed Central PMCID: PMC4226781.

11. American Medical Association [Internet]. 2025 [cited 2026 Feb 2]. Medicare Basics series: Advancing value-based care with alternative payment models. Available from: https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-basics-series-advancing-value-based-care-alternative

12. American Medical Association. Behavioral health opportunities in value-based care: Guidance for physician practices [Internet]. Washington, DC: American Medical Association; 2025 Aug [cited 2026 Feb 1]. Report No. Available from: https://www.ama-assn.org/system/files/behavioral-health-value-based-care.pdf

13. America’s Health Insurance Plans. Integrating Behavioral Health and Primary Care: Better Care and Health for the Whole Person [Internet]. Washington, DC: America’s Health Insurance Plans; 2022 Feb [cited 2025 Sep 12]. Report No. Available from: https://ahiporg-production.s3.amazonaws.com/documents/202202-AHIP_IB_Behavioral_Health_Integration-004.pdf

14. Marcotte LM, Reddy A, Zhou L, Razliff A, Unützer J, Chang D, et al. Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare. Psychiatr Serv. 2021 Jul;72(7):822-825. doi:10.1176/appi.ps.202000265

15. Cross DA, Qin X, Huckfeldt P, Jarosek S, Parsons H, Golberstein E. Use of Medicare’s Behavioral Health Integration Service Codes in the First Two Years: an Observational Study. J Gen Intern Med. 2020 Dec;35(12):3745-3746. doi:10.1007/s11606-019-05579-2 PubMed PMID: 31845107; PubMed Central PMCID: PMC7728892.

16. Lombardi BM, Greeno C, de Saxe Zerden L. Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study. Fam Syst Health. 2023;41(4):527-536. doi:10.1037/fsh0000827

17. Shmerling AC, Gold SB, Gilchrist EC, Miller BF. Integrating behavioral health and primary care: a qualitative analysis of financial barriers and solutions. Transl Behav Med. 2020 Aug 7;10(3):648-656. doi:10.1093/tbm/ibz026

18. Melissa Bailey, Rachael Matulis, Kelsey Brykman. Behavioral Health Provider Participation in Medicaid Value-Based Payment Models: An Environmental Scan and Policy Considerations [Internet]. Hamilton, NJ: Center for Health Care Strategies, Inc.; 2019 Sep [cited 2026 Feb 1]. Report No. Available from: https://www.chcs.org/media/behavioral-health-provider-participation-in-medicaid-value-based-payment-models-an-environmental-scan-and-policy-considerations.pdf

19. MBA RJ Kevin Dotson, Munzoor Shaikh. The key role of downside risk in the success of value-based care. HFMA [Internet]. 2024 Jun 2 [cited 2026 Feb 2]. Available from: https://www.hfma.org/payment-reimbursement-and-managed-care/value-based-payment/the-key-role-of-downside-risk-in-vbcs-success/

20. Soper MH, Matulis R, Menschner C. Moving Toward Value-Based Payment for Medicaid Behavioral Health Services [Internet]. Available from: https://njamha.org/links/boardmeetings/CHCSpaperonVBC.pdf

21. Ross KM, Gilchrist EC, Melek SP, Gordon PD, Ruland SL, Miller BF. Cost savings associated with an alternative payment model for integrating behavioral health in primary care. Transl Behav Med. 2019 Mar 1;9(2):274-281. doi:10.1093/tbm/iby054 PubMed PMID: 29796605.

22. An Analysis of DRG Profitability and Cross-Subsidization in Academic Medical Centers [Internet]. [cited 2026 Feb 2]. Available from: https://ajhcs.org/article/an-analysis-of-drg-profitability/

23. Gaffney LK, Michelson KA. Analysis of Hospital Operating Margins and Provision of Safety Net Services. JAMA Netw Open. 2023 Apr 18;6(4):e238785. doi:10.1001/jamanetworkopen.2023.8785

24. Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions [Internet]. 2024 [cited 2026 Feb 2]. Available from: https://www.commonwealthfund.org/publications/issue-briefs/2024/jul/why-primary-care-practitioners-arent-joining-value-based-payment doi:10.26099/2cxx-0z64

Arrangements with Payers

Shifts in Risk and Responsibility

Fee-For-Service Payment Models

Alternative Payment Models

NIAC Note: Test the Waters

NIAC Note: Master the Basics

NIAC Note: Anticipate the Learning Curve

References