Aetna's Integrated Primary Care Behavioral Health Program supports a collaborative health care model that provides coordinated and effective services for individuals with mental health needs. The program offers a co-located behavioral health clinician in the primary care setting to address behavioral health, as well as health/wellness issues; facilitated access to behavioral health services; and facilitated access to disease management and case management programs for Aetna members. Through this program, the primary care physician refer patients, as clinically indicated, to the behavioral health clinician who will see patients within the primary care setting for up to three sessions. Both the behavioral health clinician and the primary care physician communicate on a regular basis (e.g., written reports about interventions and patient progress are provided to the primary care provider).
Behavioral health clinicians (licensed psychologists - Masters or PhD level, licensed social workers - Masters level minimum, or licensed professional counselors - Masters level minimum), delivering behavioral health services in primary care offices may submit claims to Aetna for the first three (3) patient sessions using the following codes: Diagnosis Code: V40.9 (Unspecified mental or behavioral problem) and Procedure code: 99242. Office consultation for a new or established patient, which requires these three key components: An expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
