CMS Proposes Rule to Cover Collaborative Care Services

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CMS Proposes Rule to Cover Collaborative Care Services
Update: On November 15, 2016, The Centers for Medicaid and Medicare Services (CMS) published the final rule to the 2017 Medicare Physician Fee Schedule. More information about the final rules, including a 2-page cheat sheet summarizing the codes, can be found on our Financing Strategies for Collaborative Care page.

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In July 2016, The Centers for Medicaid and Medicare Services (CMS) published a proposed rule to the 2017 Medicare Physician Fee Schedule that includes coverage for behavioral health collaborative care. This change allows primary care clinics to bill Medicare for collaborative care management (CoCM) tasks such as psychiatric consultation and care manager interventions and follow-up over time. The CMS rule covers CoCM for Medicare patients with common behavioral health diagnoses that are frequently encountered and diagnosed in primary care, not just CoCM for patients diagnosed with depression. Under the proposed rule, CoCM services would be billable in 2017 under a series of G codes. The specific G codes proposed by CMS in can be found on page 41 of the Medicare 2017 Physician Fee Schedule. The proposed rule is open for public comment through September 6, 2016.

New Codes Support Wider Use of Population-Based Psychiatric Consultation
“When I have presented [CoCM] to psychiatrists and primary care practices in the past, the most common concern has been a need for a viable payment system,” explained Mark Williams, MD, a psychiatrist in the Mayo Clinic primary care system. “The new proposal to pay for behavioral health [CoCM] is exciting as it allows us to link payment to where there is strong evidence of value,” says Dr. Williams.

“If these codes are made viable for practices to use, we increase the potential for primary care practices to attract psychiatrists into helping them manage their populations of patients at a time with huge shortages in mental health resources.”

“We are hopeful this announcement will send a message to other payers about the importance of supporting [CoCM],” says Virna Little, PsyD, LCSW-R, SAP, Senior Vice President for Psychosocial Services and Community Affairs at The Institute for Family Health in New York. “This is an important change and will provide additional support for building and sustaining collaborative care programs.”