Question 1

What are the new APCM add-on codes for behavioral health?

Accepted Answer

Starting in 2026, CMS introduced G0568, G0569, and G0570 as add-on codes for APCM specifically to account for the increased intensity of Behavioral Health Integration (BHI). These codes allow psychiatric practices to capture the additional resources required for managing complex mental health conditions alongside standard primary care management.

Question 2

How do G0568-G0570 codes differ from standard BHI codes?

Accepted Answer

Unlike traditional BHI codes (99484), the new APCM add-on codes are designed to be bundled with the APCM base payment. They reflect the continuous nature of psychiatric care rather than episodic interventions, requiring specific documentation of ongoing monitoring for conditions like major depressive disorder or bipolar disorder.

Question 3

Can I bill APCM alongside Collaborative Care Model (CoCM) services?

Accepted Answer

Generally, APCM is intended to streamline various care management programs. While CoCM (99492-99494) remains a distinct high-intensity model, practices must ensure they are not double-billing for the same time increments. AI-driven call logs provide the precise time-stamped documentation needed to audit and separate these service hours effectively.

Question 4

What documentation is required for the psychiatric APCM add-on?

Accepted Answer

Documentation must show at least 20 minutes of care management per month, specifically addressing the behavioral health component. This includes medication reconciliation, therapy referrals, and progress monitoring. AI call handling systems automatically generate the necessary transcripts and summaries to justify these billing increments.

Question 5

Which psychiatric conditions qualify for APCM enrollment?

Accepted Answer

Chronic conditions expected to last at least 12 months qualify. In behavioral health, this includes Major Depressive Disorder, Generalized Anxiety Disorder, Schizophrenia, Bipolar Disorder, and Substance Use Disorders. Each must be documented as a chronic condition requiring a structured care plan and regular follow-up.

Question 6

How must depression and anxiety be documented for APCM?

Accepted Answer

Documentation should include standardized tool results (like PHQ-9 or GAD-7), a longitudinal care plan, and evidence of medication management. AI-powered outreach can automate the collection of these assessment scores between visits, ensuring the clinical record is always current for APCM compliance.

Question 7

What are the requirements for medication management documentation?

Accepted Answer

Practices must document the review of psychiatric medications, assessment of side effects, and adherence checks. For APCM, this monitoring can be performed via telephonic outreach. Tile's AI call center can conduct these adherence checks and log the responses directly into the patient's record for audit-proof billing.

Question 8

Does a substance use disorder qualify as a chronic condition under APCM?

Accepted Answer

Yes, Substance Use Disorder (SUD) is recognized as a chronic condition for APCM. Documentation must reflect the ongoing management of the disorder, coordination of recovery services, and monitoring of medication-assisted treatment (MAT) where applicable, often involving more frequent touchpoints than standard psychiatric care.

Question 9

How does APCM documentation handle 42 CFR Part 2 for SUD patients?

Accepted Answer

For patients with SUD, 42 CFR Part 2 requires specific, informed consent before sharing records or billing for integrated services. Our AI systems are programmed to verify and record these specialized consents during initial outreach, ensuring that all subsequent APCM documentation remains compliant with federal privacy laws.

Question 10

What consent is required for psychiatric APCM enrollment?

Accepted Answer

CMS requires documented verbal or written consent for APCM services. For behavioral health, this must include an explanation of the BHI add-on codes and potential cost-sharing. AI call automation can standardize this consent process, ensuring every patient receives a consistent explanation and their agreement is recorded.

Question 11

How does AI ensure HIPAA compliance during patient outreach?

Accepted Answer

Tile’s AI platform utilizes end-to-end encryption and secure data silos. For behavioral health, this means sensitive psychiatric notes and SUD data are handled with elevated security protocols. The AI only accesses the minimal necessary information required to facilitate the care management call and update the EHR.

Question 12

How is crisis intervention documented within the APCM framework?

Accepted Answer

While APCM focuses on chronic management, crisis touches must be documented to show care coordination. AI call handling can identify high-risk keywords during patient interactions, immediately escalating the call to a provider while simultaneously documenting the event to support the medical necessity of the APCM care plan.

APCM Compliance Guide for Behavioral Health & Psychiatry

2026 APCM Codes & Billing Requirements

Clinical Documentation & Condition Eligibility

Regulatory Compliance & Specialized Consent

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