Here are guidelines for billing collaborative care

The Collaborative Care Model, also known as CoCM, is a benefit for all our members, including seniors and Blue Care Network members, who see a primary care physician who uses this model. There are no member cost-sharing requirements for the use of CoCM.

As you read in an October Record article, this integrated behavioral care model allows a primary care physician to more effectively treat patients with behavioral health conditions, such as depression and anxiety.

This model requires three provider types, working together as a team and focusing on the following responsibilities:

• A primary care physician, who retains responsibility for patient treatment plans and billing.
• A behavioral health care manager, who works closely with the patient, administers screening assessments, conducts weekly systematic case review with a consulting psychiatrist and serves as a liaison between the primary care physician and the consulting psychiatrist.
• A consulting psychiatrist, who consults with the care manager each week to review the patient’s response to treatment and their behavioral screening results. The psychiatrist doesn’t meet with the patient as part of this model.

Keep in mind that there are some specific billing requirements when using this model. Neither the behavioral health care manager nor the psychiatrist submits claims for CoCM services. The primary care physician bills for services provided by the care team over a calendar-month service period.

Billing basics

• Bill per member, per calendar month.
• For each month, bill for the time spent by all clinical team members but don’t duplicate shared time. For example, if the care manager and psychiatrist meet for 10 minutes, you would bill for 10 minutes in total, not 10 minutes for the care manager and another 10 minutes for the psychiatrist.
• There must be a separate initiating billable visit with the primary care physician  prior to billing CoCM codes for patients not seen within one year. This visit includes establishing a relationship with the patient, assessing the patient prior to referral, and obtaining patient consent to consult with specialists.
• Consent may be verbal or written but must be documented in the electronic health record.
• CoCM services may be billed alone or with a claim for another billable visit; however, CoCM services can’t be billed in the same calendar month as general behavioral health integration.
• Can bill both CoCM services and Provider-Delivered Care Management claims if both types of services are rendered.

Billing codes for commercial members:

Billing codes for patients with Medicare, a Medicare Advantage plan or Medicaid:

Although CoCM has been a Blue Cross and BCN benefit since 2017, we’re working to expand its use through training and support opportunities, along with incentives. As always, please check the member’s benefits before providing services. Contact your physician organization if your practice is interested in learning more about training opportunities or incentives for using this model.

**FQHC/RHC stands for Federally Qualified Health Center/Rural Health Clinic.