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May 2022
Review these important Collaborative Care billing tips
We frequently receive questions about billing for our Collaborative Care Model, also known as CoCM, and wanted to share some key tips.
Keep in mind that Blue Cross Blue Shield of Michigan and Blue Care Network both use billing requirements established by the Centers for Medicare & Medicaid Services. If there’s any difference between Blue Cross and CMS guidelines, the CMS information prevails.
- Services must be billed under the primary care provider’s NPI.
- CoCM services are billed once per member, per calendar month, based on the number of minutes of care provided.
- Minutes billed reflect time billed by all members of the care team triad (primary care physician, behavioral health care manager, consulting psychiatrist).
- CoCM services require a separate “initiating billable visit” for patients who haven’t been seen by their primary care provider within one year.
- CoCM can be billed alone or with a claim for another billable visit.
- CoCM service codes (*99492, *99493, *99494, G2214 or G0512) can’t be billed in the same calendar month as general behavioral health integration codes (*99484, G0511).
- The primary care provider is responsible for payment to the consulting psychiatrist.
- CoCM is currently payable for all product lines. However, employer groups choose both their benefit packages and any associated cost share. Check the patient’s benefits before rendering services.
- Federally Qualified Health Centers and Rural Health Clinics must use code G0512 when billing CoCM for non-commercial members.
- FQHCs and RHCs may not use code G2214.
Some practices have said they’re receiving rejections because of frequency limitations. Refer to the chart below for information on how you can avoid such denials:
CoCM billing tips: Avoiding “same date” denials
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| 99492 and 99493 in the same month |
You wouldn’t bill an initial month code (99492) and a subsequent month code (99493) in the same month. |
| 99492 and G2214 in the same month |
99492 is an initial month code, so you wouldn’t combine with G2214, which is a code that could either be initial month or subsequent month.
If you need to bill more minutes than 99492 provides, you’d bill 99492 and units of 99494.
If you don’t have enough minutes to bill 99492, you would bill G2214 alone. |
| 99493 and G2214 in the same month |
99493 is subsequent month code, so you wouldn’t combine it with G2214, which is a code that could be either initial or subsequent month.
If you need to bill more minutes than 99493 provides, you’d bill 99493 and units of 99494.
If you don’t have enough minutes to bill 99493, you would bill G2214 alone. |
| G2214 and 99494 in the same month |
99494 is intended to be used as the add on code to either 99492 or 99493.
The system isn’t configured to allow G2214 to be billed with an add-on code. |
| 99492 and 99492 |
You wouldn’t bill two initial month codes in the same month. |
| 99493 and 99493 |
You wouldn’t bill two subsequent month codes in the same month. |
| G2214 and G2214 |
G2214 can be used for either an initial month or a subsequent month.
However, it would only be used if there weren’t enough minutes of activity to bill a either the initial month 99492 code or the subsequent month code 99493.
To maximize reimbursement, whenever possible, use the 99xxx codes rather than G2214. |
| 99494 and 99494 |
99494 is an add-on code and will not be payable unless it is combined with an initial month (99492) or subsequent month (99493) code. 99494 allows quantity units.
If you are thinking of using 99494 twice, bill “99494 – Two units” instead. |
For more information, check out these resources:
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