May 31, 2022
What is New?
Effective June 1, 2022, Blue Cross and Blue Shield of Texas (BCBSTX) must have systems and process set up to provide Collaborative Care Model (CoCm) services for our Medicaid managed care members of all ages who have a mental health or substance use condition, to include a pre-existing or suspected mental health or substance use condition, as determined by the primary care provider (PCP) (i.e., physician, physician assistant, or nurse practitioner).
What is Collaborative Care Model (CoCM)?
The CoCM is a systematic approach to the treatment of behavioral health conditions (mental health or substance use) in a primary care setting. This model combines the services of behavioral health care managers (BHCMs) and psychiatric consultants with PCP oversight to proactively manage behavioral health conditions as chronic diseases.
Requirements for Primary Care Physicians (PCP)
Effective June 1, 2022, the PCP must submit the following settings in an office, outpatient hospital, inpatient hospital, skilled nursing facility or intermediate care facility, extended care facility, and other locations for the following procedure codes:
Procedure Code |
Time Threshold |
99492 |
Initial month: First 70 minutes of services accrued during the initial calendar month of BHCM activities, in consultation with the psychiatric consultant and directed by the PCP; billable at 36 minutes, time threshold is 36 to 85 minutes |
99493 |
Subsequent months: First 60 minutes of services accrued during each subsequent calendar month of BHCM activities, in consultation with the psychiatric consultant and directed by PCP; billable at 31 minutes, time threshold is 31 to 75 minutes |
99494 |
Each additional 30 minutes of services accrued during the initial calendar month or subsequent calendar months of BHCM activities, in consultation with the psychiatric consultant and directed by the PCP; billable at 16 minutes beyond total time, up to 30 minutes |
G2214 |
Initial or subsequent months: 30 minutes of services accrued during an initial calendar month or subsequent calendar months of BHCM activities, in consultation with the psychiatric consultant and directed by the PCP; billable at 16 minutes, time threshold is 16 to 30 minutes |
Only the PCP may submit claims for CoCM services. The BHCM and psychiatric consultant are reimbursed by the PCP via a contract, employment, or other arrangements. CoCM services are individually delivered, time-based, monthly services that include the following:
- Outreach and engagement
- Completing an initial assessment
- Developing an individualized and person-centered plan of care
- Providing brief interventions and other focused treatments
- Conducting weekly caseload reviews with the psychiatric consultants
- Monitoring and tracking a person’s progress using a registry
Additional Information
Information about the benefit will be published in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) in the Texas Medicaid Provider Procedure Manual.
To ensure providers have an established CoCM program, Texas Health and Human Services Commission (HHSC) is developing an attestation form that fee-for-service providers will have to sign prior to the delivery of CoCM services. The provider will need to attest that they are actively providing care consistent with the CoCm’s core principles and specific function requirements:
- Patient-centered care
- Team structure with identified staff
- Measurement-based treatment using validated tools
- Accountable care using a registry, as described in the CoCM Medicaid medical policy
The form will be available soon for Blue Cross and Blue Shield of Texas (BCBSTX) to use or edit as needed.
Resources
For more information on registry requirements, refer to Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Psychiatry and Behavioral Sciences Division of Population Health.
For more information on payment for CoCM in primary care, refer to the American Medical Association’s webinar titled "Experts on practical billing strategies for the collaborative care model”.
Questions
For questions or additional information, please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615, or
- Submit via email to Texas Medicaid Network Department
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.