Question 1

What are the new 2026 APCM BHI add-on codes?

Accepted Answer

The primary add-on codes are G0568, G0569, and G0570. These are designed to be billed on top of base APCM codes to account for the additional resource intensity required for managing behavioral health conditions within a primary care setting, adding significant per-patient monthly revenue.

Question 2

How does G0568 differ from G0569 and G0570?

Accepted Answer

G0568 is the base BHI add-on for initial integration services. G0569 and G0570 represent higher levels of complexity or intensity, often tied to the specific Collaborative Care Model (CoCM) requirements or the severity of the patient's behavioral health diagnosis and required interventions.

Question 3

Can BHI add-ons be billed alongside standard APCM codes?

Accepted Answer

Yes, this is known as revenue stacking. Practices can bill the base APCM code (based on patient complexity) and then 'stack' the BHI add-on code if the patient meets the specific behavioral health integration criteria, potentially increasing monthly revenue by $20 to $40 per patient.

Question 4

What are the time requirements for billing G0568?

Accepted Answer

Unlike traditional CCM, APCM BHI add-ons focus on the delivery of a service bundle. While specific minute thresholds exist for certain variants, G0568 documentation must primarily reflect the systematic assessment and monitoring of the patient's behavioral health condition.

Question 5

How does TileHealthcare AI help with G-code tracking?

Accepted Answer

Our AI call center solution automatically logs patient interactions, captures verbal screening data, and timestamps clinical outreach. This creates a robust audit trail for BHI-specific time and service requirements, ensuring all G-code billing is backed by verifiable documentation.

Question 6

Is a PHQ-9 or GAD-7 score required for BHI billing?

Accepted Answer

Yes, standardized screening tools like the PHQ-9 for depression and GAD-7 for anxiety are central to BHI documentation. CMS requires regular administration of these tools to track patient progress and justify the continued necessity of behavioral health integration services.

Question 7

How often should PHQ-9 screenings be performed for APCM?

Accepted Answer

While intervals vary based on the care plan, most integrated models recommend a PHQ-9 screening at least every 30 to 90 days. AI-driven phone systems can automate these screenings by calling patients and collecting scores via natural language processing (NLP).

Question 8

What is the role of the Psychiatric Consultant in BHI billing?

Accepted Answer

For higher-level BHI codes, a psychiatric consultant must be available for regular case reviews. Documentation must show that the primary care team collaborated with the consultant to adjust medications or therapy based on the patient's screening scores and clinical progress.

Question 9

Can AI automate the collection of GAD-7 and PHQ-9 scores?

Accepted Answer

Absolutely. TileHealthcare's AI agents can reach out to patients before their scheduled APCM review, conduct the GAD-7 or PHQ-9 via voice, and instantly push the structured scores into your EMR, ensuring the documentation is ready before the billing cycle ends.

Question 10

What documentation is needed to survive a BHI audit?

Accepted Answer

Auditors look for three things: a clear behavioral health diagnosis in the care plan, evidence of systematic monitoring using validated tools (PHQ-9/GAD-7), and documentation of communication between the primary care provider and the behavioral health specialist or consultant.

Question 11

Which patients qualify for BHI add-on services?

Accepted Answer

Patients must have a documented behavioral health condition (such as MDD, GAD, or substance use disorder) that is being managed by the primary care practice. They must also be enrolled in the base APCM program for their chronic physical conditions.

Question 12

Is specific patient consent required for BHI add-ons?

Accepted Answer

Yes, patients must be informed of the BHI services and any potential cost-sharing (co-pays) associated with the add-on codes. This consent can be obtained verbally but must be documented in the medical record, a process our AI agents can facilitate during enrollment.

Question 13

How does AI improve BHI enrollment rates?

Accepted Answer

Many patients are hesitant to discuss mental health. AI outreach provides a low-pressure environment for patients to complete initial screenings. If a score indicates a need for BHI, the AI can explain the program benefits and capture consent, increasing enrollment by up to 40%.

Question 14

Can BHI be billed for patients in a Collaborative Care Model (CoCM)?

Accepted Answer

Yes, G0568-G0570 are specifically designed to align with CoCM and other integrated models within the APCM framework. They provide the financial mechanism to support the multidisciplinary team required for effective collaborative care.

Question 15

Does BHI billing apply to both Medicare and Medicare Advantage?

Accepted Answer

Yes, while these are CMS codes, most Medicare Advantage plans follow the PFS final rule and reimburse for BHI add-ons. It is essential to verify specific payer contracts to ensure G0568-G0570 are included in your value-based care agreements.

APCM BHI Billing & G-Code FAQ Guide

2026 BHI Add-on Code Fundamentals

Clinical Documentation and Screenings

Enrollment and Eligibility

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