A report published by SAMHSA that seeks “solutions to the barriers to the reimbursement of mental health services in primary care settings, specifically reimbursement by Medicare and Medicaid.”
Implementation Tool: Billing
Funding Mechanisms for Depression Care Management: Opportunities and Challenges
There is overwhelming evidence that depression care management works well for patients and is a cost-effective treatment. However, inconsistent third-party reimbursement for depression care management is a significant economic barrier to utilization and sustainability in primary care settings. Seven funding mechanisms, mostly under-utilized and not widely publicized, are described. While substantial obstacles remain in the way of fully implementing these depression care management funding mechanisms, several recent policy advancements provide some optimism for the potential adoption of financial mechanisms to support and disseminate these evidence-based practices.
Medicare Payment for Behavioral Health Integration
An article published in the New England Journal of Medicine discusses the Center for Medicare and Medicaid Sevices’ payment codes for behavioral health integration.
Quick Guide on Bundled Payments for Behavioral Health Integration Services
The Centers for Medicare & Medicaid Services (CMS) announced Medicare payments for services provided by primary care providers for patients participating in a Collaborative Care program or receiving other behavioral health integration services. This handout summarizes the four AMA CPT® codes that can be used to bill for these services.
The payment structure may be used to treat patients with any behavioral health condition that is being treated by the billing practitioner, including substance use disorders.
Quick Guide on Payments for Behavioral Health Integration Services in Federally Qualified Health Centers and Rural Health Clinics
The Centers for Medicare and Medicaid Services (CMS) published final rules that allow Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to bill for Behavioral Health Integration services, Chronic Care Management, and the Collaborative Care Model.
Basic Coding for Integrated Behavioral Health Care
There are different ways to bill for integrated behavioral health care depending on your model and staffing. This handout gives a brief overview of basic CPT and Medicare billing codes for behavioral health integration and Collaborative Care.
Remember to check with your state and all payers to determine the necessary qualifications for the designated billing providers. Not all states or payers reimburse for every code.
Behavioral Health Integration Services Fact Sheet
The Centers for Medicare and Medicaid Services have an updated fact sheet detailing codes that can be used to bill for behavioral health integration (BHI) and Collaborative Care Model (CoCM) services.
Quick Guide on Medicare Payments for Office-Based Substance Use Disorder Services
In January 2021, the Centers for Medicare & Medicaid Services (CMS) announced that the bundled payments for the overall treatment of OUD can be used for any substance use disorder or treating several at one time. This quick guide summarizes the codes that can be used to bill for these services.
Frequently Asked Questions for Billing Collaborative Care
Since hosting monthly finance office hours, the AIMS Center has compiled the most asked questions and their answers. Answers address a variety of billing and financing topics including: reimbursement, the CoCM team, general BHI code, patient cost, registry options, telehealth, time tracking and more.
Updated 03/28/2023
Guidance on Verbal Patient Consent and CoCM
Ensuring that a patient understands the Collaborative Care (CoCM) program before agreeing to participate is a crucial task for primary care providers. This resource provides general guidance on obtaining verbal consent from patients to participate in CoCM. Please note that these are general tips and that specific consent requirements may vary by state and patient insurance.