Improving Payment for Collaborative Mental Health Care in Primary Care

Area of Science:

• Health Services Research
• Primary Care Medicine
• Mental Health Integration

Background:

• The Collaborative Care Model is evidence-based for primary care settings.
• Current Procedural Terminology (CPT) codes (99492-99494) introduced in 2018 allow separate reimbursement for collaborative care.
• These codes reimburse for monthly time spent by care team members, including behavioral care managers, primary care providers, and consulting psychiatrists.

Purpose of the Study:

• To reflect on challenges encountered by healthcare organizations implementing time-based billing for collaborative care.
• To provide suggestions for the implementation and future refinement of reimbursement codes.

Main Methods:

• Analysis of experiences from multiple healthcare organizations.
• Qualitative reflection on implementation challenges and proposed solutions.

Main Results:

• Time-based billing for CPT codes 99492-99494 presents practical difficulties for providers.
• Identified challenges in accurately capturing and billing for collaborative care team time.

Conclusions:

• Further refinement of reimbursement codes is necessary for effective implementation.
• Recommendations include transitioning to a 30-day reimbursement cycle and adopting new codes for smaller time increments, such as those proposed by the Centers for Medicare and Medicaid Services.