Plan Sustainable Financing for Integrated Care

Integrated Health CoE Resource
Published:
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Identify funding opportunities, evaluate reimbursement strategies, and build a sustainable financing roadmap for bi-directional integrated care.

Start the Decision Support Tool: Integrated Care Revenue Estimator
About This Resource

This integrated care financing collection helps organizations plan, evaluate, and strengthen sustainable financing strategies for bi-directional integrated care. The resources focus on practical coverage, billing, reimbursement, staffing, and implementation considerations across physical health, mental health, and substance use services.

Intended users:

    • State agencies and Medicaid partners assessing coverage, payment policy, and implementation options.

    • Payers and managed care organizations reviewing integrated care service coverage and reimbursement opportunities.

    • Provider organizations, including community-based mental health, substance use, primary care, and physical health providers, planning or expanding integrated care services.

    • Academic and research institutions studying integrated care financing, billing models, or service sustainability.

Use these resources to:

    • Identify coverage and reimbursement opportunities for integrated care services.

    • Understand common billing, staffing, documentation, and payer considerations.

    • Connect financing strategies to real-world implementation decisions.

    • Support planning alongside payer-specific guidance, state Medicaid requirements, managed care policies, and organizational data.
How It Works

The integrated care financing collection is organized around a four-step pathway that helps users move from service-specific context to practical revenue modeling:

    1. Review the financing modules for service-specific context and implementation considerations.
    2. Use the Decision Support Tool: Integrated Care Revenue Estimator to explore integrated care billing codes and reimbursement assumptions.
    3. Sort and filter the tool to focus on the payers, services, provider types, and settings most relevant to your organization.
    4. Model potential revenue opportunities using built-in use cases or customized assumptions.

The resources can be used together or separately depending on where you are in the planning process. Users who are new to integrated care financing may want to begin with the overview content and modules. Users who are ready to test service delivery or reimbursement assumptions may prefer to start with the Decision Support Tool: Integrated Care Revenue Estimator and how-to videos.

Decision Support Tool: Integrated Care Revenue Estimator

At a Glance
Billing & Implementation Focus
Use this Module To

The Decision Support Tool: Integrated Care Revenue Estimator is an Excel-based resource that helps organizations estimate potential revenue opportunities for integrated care services across different payers and billing scenarios. The tool consolidates integrated care billing codes across modules and allows users to review reimbursement estimates, eligible provider types, telehealth considerations, documentation or time requirements, and related source guidance.

Time to use: 15–30 minutes
Difficulty: Intermediate/Advanced
Updated: May 2026

Integrated Care Revenue Estimator

Video clips:
    • Getting Started: Learn how the workbook is organized, what information is included in each worksheet, and where to begin.
    • How to Sort & Filter: Use the state selector, column filters, and sorting tools to narrow results by payer, service category, integration setting, provider type, and other factors.
    • Model a Use Case: Customize assumptions such as patient volume, payer mix, retention, service frequency, and no-show rates to estimate potential annual revenue for a specific service line.
The tool includes background information, user instructions, a comprehensive billing code inventory, and pre-built use cases that can support planning for new or expanded services.
Organizations can use the tool to explore current billing opportunities, compare assumptions across payers, and model revenue for common integrated care delivery models.

Financing Modules

icon of a person with arrows pointing out circling it Care Coordination and Integration Billing

At a Glance
Billing & Implementation Focus
Use This Module To

This 33-page module serves as a practical billing code and implementation reference for bi-directional care coordination and integration, including billing codes that support primary care and other medical office providers, billing codes that support mental health and substance use treatment providers, and tips for building sustainable integrated care programs.

Time to complete: 25–60 minutes
Difficulty: Intermediate/Advanced
Updated: October 2025

Download Care Coordination Module
Review billing codes and considerations that support primary care and other medical office providers, behavioral health and substance use treatment providers, and cross-setting care coordination activities.
Clarify which care coordination activities may be billable, identify workflow and staffing implications, and support sustainability planning for bi-directional integrated care programs.

icon of a bottle with a hospital plus sign on it Finance MOUD Services

At a Glance
Billing & Implementation Focus
Use This Module To

This 13-page module provides practical guidance on Medication for Opioid Use Disorder (MOUD) financing strategies, including the coverage landscape, core MOUD services, revenue cycle considerations, staffing approaches to maximize reimbursement, sustainable partnerships, care coordination, care transitions, and preparation for value-based payment.

Time to complete: 20–45 minutes
Difficulty: Intermediate/Advanced
Updated: November 2022

Download MOUD Financing Module

Review coverage considerations, core MOUD services, revenue cycle issues, staffing approaches to maximize reimbursement, sustainable partnership opportunities, care coordination, care transitions, and preparation for value-based payment.
Identify financing strategies for MOUD services, understand billing and staffing considerations, and plan for sustainable implementation within integrated care settings.

icon of a piece of paper and pencil Improve Screening Reimbursement

At a Glance
Billing & Implementation Focus
Use This Module To

This 4-page module provides practical guidance on financing strategies for physical health, mental health, and substance use disorder screenings, including the coverage landscape, coding considerations, mental health and substance use disorder screening in primary care settings, primary care screening in mental health and substance use treatment settings, and coding options.

Time to complete: 10–20 minutes
Difficulty: Intermediate/Advanced
Updated: November 2022

Download Screening Module

Review screening coverage considerations, coding options, opportunities to support mental health and substance use disorder screening in primary care settings, and approaches to support primary care screening in mental health and substance use treatment settings.
Determine which screening activities may support reimbursement, strengthen coding and documentation practices, and align screening workflows with integrated care delivery.

icon of a stethoscope Support Metabolic Monitoring

At a Glance
Billing & Implementation Focus
Use This Module To

This 5-page module provides practical guidance on financing strategies for metabolic monitoring, including rationale and definitions, coding strategy, and preparation for value-based payment.

Time to complete: 10–20 minutes
Difficulty: Low/Intermediate
Updated: November 2022

Download Metabolic Monitoring Module

Review the rationale for metabolic monitoring, relevant definitions, coding strategy, and opportunities to prepare for value-based payment.
Identify financing strategies for metabolic monitoring, connect monitoring activities to coding options, and support implementation planning within integrated care settings.

icon of two hands around a heart Expand Tobacco Treatment Services

At a Glance
Billing & Implementation Focus
Use This Module To

This 15-page module provides insights and strategies for tobacco use disorder treatment financing, including minimum coverage standards, general coding strategies and documentation tips, eligible staff, and billing across physical health and behavioral health settings.

Time to complete: 20–45 minutes
Difficulty: Low/Intermediate
Updated: September 2024

Download Tobacco Use Disorder Treatment Module

Review minimum coverage standards, general coding strategies, documentation tips, eligible staff considerations, and billing approaches across physical health and behavioral health settings.
Determine how tobacco treatment services can be built into routine care, identify billable touchpoints, and support planning for expanded treatment services across integrated care settings.

Webinar & Training Resources

Additional Resources

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This tool was supported by the National Council for Mental Wellbeing’s Center of Excellence for Integrated Health Solutions and funded by a grant award from the Substance Abuse and Mental Health Services Administration and managed by the National Council for Mental Wellbeing. The views, opinions and content expressed in this report do not necessarily reflect the views, opinions or policies of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services.

Center of Excellence

The Center of Excellence for Integrated Health Solutions provides resources, training and technical assistance to advance the integration of primary and behavioral health care.

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