Integrated Care
Learn more about how to implement the Collaborative Care Model, including reimbursement for the model and funding opportunities available.
APA's Support and Alignment Network and the Advancing Integrated Mental Health Solutions (AIMS) Center, in collaboration with the Institute for Family Health, created the Financial Modeling Workbook, which helps practices more accurately:
- Estimate visit volume and the number of patients served;
- Define and analyze how much time staff engage in key integrated care tasks; and
- Estimate fee-for-service and G-code potential revenues
Register and download the Financial Modeling Workbook here.
APA Webinar – Introduction to the Financial Modeling Workbook
APA hosted a webinar to introduce the Financial Modeling Workbook which helps to assist practices in determining their net financial impact of implementing collaborative care.
View Webinar
Questions About the Workbook?
Below is the schedule for the upcoming APA monthly office hours.If you have questions, please contact SAN@psych.org.
- Wednesday, May 2: Noon – 1:00 p.m. ET
- Wednesday, June 6: Noon – 1:00 p.m. ET
- Wednesday, July 11: Noon – 1:00 p.m. ET
- Wednesday, August 1: Noon – 1:00 p.m. ET
- Wednesday, September 5: Noon – 1:00 p.m. ET
- Wednesday, October 3: Noon – 1:00 p.m. ET
- Wednesday, November 7: Noon – 1:00 p.m. ET
- Wednesday, December 5: Noon – 1:00 p.m. ET
Office Hours Dial-In Information
Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/760751576
Telephone: (646) 876 9923 or (408) 638 0968
Meeting ID: 760 751 576
PTNs provide FREE on-the-ground support for clinicians of all types as they prepare for value-based payments. PTNs provide resources related to the triple aim of improving quality, improving the patient experience, and decreasing costs. Examples of PTN support include:
- Quality improvement assistance
- Workflow redesign
- Data collection and analysis
- EMR optimization
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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 a 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: Care Management – Behavioral Health Integration
APA Free Webinar – Getting Paid in Primary Care for Psychiatric Collaborative Care Services
This webinar will provide necessary information on coding and documentation requirements to enable primary care practices that are providing psychiatric collaborative care services to bill appropriately for these services. 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 physician, behavioral health care manager and a psychiatric consultant. This webinar will provide specific information about the codes, including a description of the work and required elements. At the conclusion of the webinar the participant should 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
This guide is an introduction to the process of implementing Collaborative Care, from the crucial first step of understanding what it is to monitoring outcomes once Collaborative Care is in place. Each step contains learning objectives along with materials to help you achieve them.
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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 Models as the 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.