Reimbursement for the Collaborative Care Model
Primary care practices that are providing collaborative care services can bill for those services using CPT® codes for Psychiatric collaborative care management services (99492, 99493, 99494 and G2214). Medicare, commercial payers, and many Medicaid plans are also providing coverage– check the local coverage policies in your area to determine coverage. Federally Qualified Health Centers and Rural Health Clinics can bill for these services using HCPCS code G0512 (for the initial 70-minute or subsequent 60-minute visits).
The Centers for Medicare and Medicaid Services (CMS) has developed a fact sheet (.pdf) and FAQs (.pdf) that describe CoCM services and their associated billing requirements, as well as provides information on a brief care management service, General behavioral health integration care management (99484). They have classified all of these (99492, 99493, 99494 and 99484) as Behavioral Health Integration (BHI) services on their care management site.
The AIMS Center has developed responses for a list of frequently asked questions (.pdf) from monthly office hours on collaborative care.
The American Psychiatric Association has compiled an interim list of payers who have either indicated they have approved coverage for psychiatric collaborative care management (CoCM) codes (CPT codes 99492-99494) or for whom we have confirmation that a paid claim(s) has occurred. It is a dynamic list so it is important to confirm coverage on a payer by payer basis.
Best Practices for Reimbursing the Collaborative Care Model in Medicaid
Learn more about Medicaid and the Collaborative Care Model in this new toolkit from APA.
[Webinar Recording] Billing, Workflow and Administrative Tools for Successful implementation of the Collaborative Care Model
This webinar provides practical information on how to overcome common barriers to practice transformation and sustainability including:
- Collaborative Care Model billing requirements,
- Documentation, and
- Clinical workflow challenges.
[APA Webinar Recording] Getting Paid in Primary Care for Psychiatric Collaborative Care Services
This webinar provides the necessary information on coding and documentation requirements to enable primary care practices that are providing psychiatric collaborative care services to bill appropriately. The majority of mental health care is provided in primary care settings. There is substantial evidence that care and outcomes improve when psychiatric expertise is made available to primary care providers through an evidence-based psychiatric Collaborative Care Model. While this model has been well-studied, there was no consistent reimbursement mechanism in place to cover the cost of providing services until 2017. There are now billing codes for Psychiatric collaborative care management services (99492, 99493, 99494) that replace the HCPCS codes referenced in the original webinar. The billing codes cover the costs associated with the work of the treatment team, which includes a primary care provider, behavioral health care manager and a psychiatric consultant. This webinar provides specific information about the codes, including a description of the work and required elements. At the conclusion of the webinar participants will be able to identify and appropriately bill for this service as part of a range of services they are providing for patients with behavioral health conditions.