Mental Health

The Psychiatric Collaborative Care Model

The psychiatric CoCM was introduced in 2018 and Medicare began making separate payments using CPT codes 99492, 99493 and 99494. Effective 1/1/2021, G2214 was added to Psychiatric CoCM to cover shorter increments of provided services.

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Psychiatric Collaborative Care Services

Psychiatric CoCM is an approach to BHI that enhances “usual” primary care by adding two key services to the primary care team:

  • Care management support.
  • Regular psychiatric consultation.

Psychiatric CoCM uses a team based approach with the following care team members:

  • Treating (Billing) Practitioner – Physician and/or nonphysician practitioner (physician assistant or nurse practitioner); typically primary care; can be of another specialty (example, cardiology, oncology).
  • Behavioral Health Care Manager – A designated individual with formal education or specialized training in behavioral health (includes social work, nursing, or psychology), working under the oversight and direction of the billing practitioner.
  • Psychiatric Consultant – Medical professional trained in psychiatry and qualified to prescribe the full range of medications.
  • Beneficiary – Involved in care planning process.

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Eligible Conditions

Eligible conditions for the delivery of Psychiatric CoCM include any mental, behavioral health or psychiatric condition(s), including substance abuse disorders, treated by the billing practitioner and in the clinical judgement of the billing practitioner warrants BHI services.

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Service Components

Psychiatric CoCM service components include:

  • Initial assessment.
    • Initiating visit. (if required, billed separately)
    • Administration of applicable validated rating scale(s).
  • Care planning with team.
  • Proactive and systematic follow-up with behavior health care manager.
  • Regular caseload review with from the psychiatric consultant.

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Billing Codes

The following billing codes are used to bill monthly CoCM services, each billing code has specific time requirements that must be met per calendar month:

  • CPT 99492 – 70 minutes per calendar month (1st or initial month)*
  • CPT 99493 – 60 minutes per calendar month (subsequent months) *
  • CPT 99494 – 30 minutes each additional 30 minutes per calendar month (any month)*
  • HCPCS G2214 – 30 minutes per calendar month (initial or subsequent months)
  • HCPCS G0512 (FQHC and RHC only) – Minimum of 70 minutes per calendar month (Initial) & Minimum of 60 minutes per calendar month (subsequent)

(*CPT Time Rule - visit the American Psychiatric Association, FAQs for billing Psychiatric Collaborative Care Management for more details)

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Frequently Asked Questions

  1. Who bills for psychiatric CoCM services?

    Answer: The primary care provider or treating practitioner submits claims for CoCM services. The behavior health care manager and psychiatric consultant is paid through the PCP or treating practitioner through direct employment, contract, or another arrangement.
     
  2. How can I begin providing psychiatric CoCM services to beneficiaries within my practice?

    Answer: After it is identified that a beneficiary can benefit from psychiatric CoCM services, an initial assessment is completed by the primary care team. The initial assessment includes the initiating visit, if required, and separately billed and administration of validated rating scale(s). Prior to the start of psychiatric CoCM services, the beneficiary must provide advanced consent (verbal or written) which must be documented in the patient record. The beneficiary must also be informed that cost sharing applies to both face-to-face and non-face-to-face provided services.
     
  3. What are the qualification requirements for a behavior health care manager role?

    Answer: The behavior health care manager is a designated member of the care team with specialized behavior health education or training. Specialized education may include a range of disciplines, for example, social work, psychology and nursing; however, Medicare has not specified the minimum education requirement for behavior health care manager. The behavior health care manager will provide the most frequent, direct and continuous services with the beneficiary. The behavior health care manager must also have a collaborative, integrated relationship with the rest of the care team.
     
  4. What date of service should be used on a professional claim if we are providing psychiatric CoCM services with multiple dates of services within a calendar month?

    Answer: The service period for CoCM is one calendar month. CMS expects that CoCM services continue to be provided, even after the time thresholds are met. After the minimum time requirements are met, the practitioner may submit the claim and does not need to hold the claim until the end of the month. The CPT time rule also applies to CoCM CPT Codes: 99492, 99493 and 99494.

For complete details on psychiatric CoCM delivery and billing requirements, including the CPT time rule, please see the following resources:

Reviewed 10/10/2023