New payments for Psychiatric Collaborative Care Services (COCM) from Medicare

June 29th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   Behavioral Health|Psychiatry|Psychology   Medicare  
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Medicare has agreed to make separate payments to physicians and non-physicians for Behavioral Health Integration (BHI) services beginning Jan. 1st, 2017.

Any condition new or pre-existing behavioral health or substance use disorders are eligible.  Beneficiaries may have comorbid, chronic, or other medical conditions they are being treated for as well.

Using the new codes, you bill the Place-of-Service POS where the practitioner provides face-to-face care.  A separate payment can now be made to the hospital (including critical access hospitals) when a practitioner reports the POS as hospital outpatient.

G0502 Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements:

  • Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional;
  • Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan;
  • Review by the psychiatric consultant with modifications of the plan if recommended;
  • Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and
  • Provision of brief interventions using evidence-based techniques such as behavioral activation,
  •  Motivational interviewing, and other focused treatment strategies.

G0503 Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements:

  •  Tracking patient follow-up and progress using the registry, with appropriate documentation;
  • Participation in weekly caseload consultation with the psychiatric consultant;
  • Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician
  • or other qualified health care professional and any other treating mental health providers;
  • Additional review of progress and recommendations for changes in treatment, as indicated, including
  • medications, based on recommendations provided by the psychiatric consultant;
  • Provision of brief interventions using evidence-based techniques such as behavioral activation,
  • motivational interviewing, and other focused treatment strategies;
  • Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharged from active treatment.

G0504 Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure) (Use G0504 in conjunction with G0502, G0503).

G0507 Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional time, per calendar month.

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