Integrated Care
Learn more about how to get paid in primary care for the Collaborative Care Model (CoCM), including reimbursement for the model and funding opportunities available.
Primary care practices that are providing collaborative care services can now bill for those services using CPT® codes for Psychiatric collaborative care management services (99492, 99493, 99494). Medicare, and some commercial payers, and 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 provided a fact sheet and a short list of FAQs 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:
This APA FAQ provides an overview of the CoCM CPT codes and the associated requirements for billing. This resource mirrors CMS' MLN fact sheet on Behavioral Health Integration 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 now. There are now new billing codes for Psychiatric collaborative care management services (99492, 99493, 99494) that replace the HCPCS codes referenced in the original webinar. The new 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.
This activity is supported by the Transforming Clinical Practice Initiative (TCPI).
View Webinar
View resources for psychiatrists advocating for Medicaid payment for the Collaborative Care Model. This includes:
- Overview of the Collaborative Care Model
- Talking points to use when speaking with payers
- Funding streams available for implementation, including states with 1115 waivers
- Examples of states implementing the model through legislation and Medicaid waivers, and
- Additional resources about the Collaborative Care Model
View the Toolkit
Opportunities for Implementing the Codes
Comprehensive Primary Care Plus (CPC+) model
CMS released an FAQ verifying the Collaborative Care Codes may be used in certain cases for the Comprehensive Primary Care Plus (CPC+) model, the largest initiative supported by CMS to transform and improve how primary care is delivered and reimbursed.
SAMHSA Grants – Promoting Integration of Primary and Behavioral Health Care
In March 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the availability of up to $110 million over five years to support the integration of primary and behavioral health care. An allowable use of funds is for grants to work with the State Medicaid office on the Collaborative Care Codes to determine how they may align to support sustainability of integrated care efforts.
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State Medicaid Offices
State Medicaid offices may also consider how to incorporate the Collaborative Care Model as they consider Medicaid redesign opportunities, such as those under Section 1115 waivers.
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Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Effective January 1, 2018, RHCs and FQHCs can receive reimbursement for general BHI and psychiatric collaborative care management services (CoCM) using two new billing codes created exclusively for RHC and FQHC payments.
For CoCM, use G0512 on an RHC or FQHC claim, either alone or with other payable services, when 70 minutes or more of initial psychiatric CoCM services or 60 minutes or more of subsequent psychiatric CoCM services are furnished. Payment for these services is set annually based on the average of the national non-facility PFS payment rate for CPT codes 99492, 99493. When reporting HCPCS code G0512 as a stand-alone billable visit a FQHC payment code is not required.
For General BHI services, use G0511 on a RHC or FQHC claim, either alone or with other payable services for 20 minutes or more of service. Payment for these services is set annually based on the average of the national non-facility PFS payment rate for CPT codes 99490, 99487 and 99484. When reporting HCPCS code G0511 as a stand-alone billable visit a FQHC payment code is not required.