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Getting Paid in the Collaborative Care Model

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.

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 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 (.pdf)

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.

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