Medicare Advantage Preferred Provider Organization (MA PPO)

Applicable to enrollees from other Blue Cross Blue Shield Medicare Advantage Plans who obtain health care services within the 5-county Philadelphia service area.

Notification

Psychiatric Collaborative Care Management (CoCM)

Notification Issue Date:

This new policy will become effective 05/30/2022. It has been developed to address the Psychiatric Collaborative Care Management (CoCM) services. The Company may provide reimbursement for CoCM services subsequent to review and approval of the primary care provider's CoCM program.

__________________

Note: On May 24, 2022, this policy in Notification was updated to clarify the reimbursement statement for the Psychiatric Collaborative Care Management (CoCM) services. The Company is also communicating the continuous coverage position on General Behavioral Health Integration services in this policy.

Title:

Psychiatric Collaborative Care Management (CoCM)

Policy #:

MA00.052b

Policy

PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT

Psychiatric Collaborative Care Management (CoCM) services may be eligible for reimbursement consideration by the Company to the primary care provider when the primary care provider submits a CoCM program and receives approval from the Company. Under the Collaborative Care model, the member is managed through a team approach typically involving a primary care provider, behavioral health care manager, and a psychiatric consultant.

Psychiatric CoCM services that are not part of a qualified CoCM program with the Company are considered covered, but these services are not eligible for separate reimbursement whether billed alone or in conjunction with other services.

CoCM QUALIFICATION PROCESS

CoCM Program must include all the following components:

Evidence of a written contractual agreement or employment of a Psychiatric Consultant in the same organization as the primary care provider
Evidence of employment of a full-time Behavioral Health Care Manager in the same organization as the primary care provider
Job description for the behavioral health care manager with formalized training or specialized education in behavioral health (including social work, advance practice nursing, or psychology)
Program description that demonstrates a collaborative, integrated relationship between the behavioral health care manager and the rest of the team members
Plan for identification, outreach, and engagement directed by a primary care provider
Written workflows documenting:

Process for an initial assessment, including administration of validated scales and resulting treatment plan
Psychiatric consultation and referral process
Evidence-based treatment interventions to be used in working with individuals (i.e., behavioral activation, problem solving treatment, other focused treatment activities)
Plans for ongoing collaboration and coordination with primary care provider and any other treating providers
Relapse prevention planning and preparation for discharge from active treatment

Demonstrated use of an electronic medical record--integrated registry for tracking follow-up and progress
Evidence of weekly caseload review with psychiatric consultant
Evidence of monitoring of patient outcomes using validated rating scales

All CoCM program submissions must be sent to collaborativecarepolicy@ibx.com for review and approval. The following information should be included with the program submission:

1. Program descriptions
2. Billing provider information
3. Billing provider number
4. National Provider Identification

GENERAL BEHAVIORAL HEALTH INTEGRATION

General Behavioral Health Integration (BHI) services are covered by the Company, but these services are not eligible for separate reimbursement whether billed alone or in conjunction with other services. Participating professional providers may not bill members for these services.

REQUIRED DOCUMENTATION

ADVANCE CONSENT

Prior to beginning CoCM services, the individual must give the primary care provider permission to consult with relevant specialists, which would include conferring with a psychiatric consultant. The individual consent may be verbal or written but must be documented in the medical record.

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS

Procedure codes representing Psychiatric Collaborative Care Management (CoCM) should only be reported by the primary care provider in the outpatient setting. These procedure codes are reported based on the total number of minutes toward the CoCM services with the individual during a calendar month period. The psychiatric consultant and behavioral health care manager may not report the CoCM procedure codes separately.

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Guidelines

This policy is consistent with Medicare's coverage determination. The Company's payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, Psychiatric Collaborative Care Management (CoCM) Services are covered under the medical benefits of the Company's Medicare Advantage products.

Description

PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT

Psychiatric Collaborative Care Management (CoCM) refers to services provided to an individual seen in a primary care setting who is diagnosed with a mental health or substance use disorder. CoCM is a model under Behavioral Health Integration (BHI) services that utilizes regular psychiatric inter-specialty care for individuals receiving BHI treatment. CoCM services are provided through the primary care provider in collaboration with a psychiatric consultant, who reviews the clinical status of the individual and makes recommendations. The primary care team reviews weekly the individual's treatment plan and status with the psychiatric consultant and maintains or adjusts the treatment plan with referrals to specialties in behavioral health as needed.

The CoCM services are reported by the primary care provider to account for their work, and the work of the psychiatric consultant and the behavioral health care manager. The services include required elements based on the evidence-based CoCM — patient engagement and assessment, tracking progress and treating to target goals, consultation with psychiatric consultant, and management of an individual as part of a population of patients. The reporting of the services is based on the work performed and the total number of minutes spent by the primary care provider and the behavioral health care manager over the course of a calendar month.

Initiating Visit

An initiating visit is required for new patients or individuals not seen within one year prior to start of CoCM services. This visit establishes the individual's relationship with the primary care provider and ensures the primary care provider assesses the individual prior to initiating CoCM services.

Primary Care Provider (Billing Provider)

Oversees the individual's care, including prescribing medications, providing treatments for medical conditions, and making referrals to specialty care when needed
Directs the behavioral health care manager or clinical staff
Remains involved through ongoing oversight, management, collaboration, and reassessment

Behavioral Health Care Manager

A designated care team member with formal education or specialized training in behavioral health (including social work, nursing, or psychology), who is employed by the same organization and works under the oversight and direction of the primary care provider
Delivers assessment and care management services, including the administration of validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for individuals who are not progressing or whose status changes; provision of brief psychosocial interventions; ongoing collaboration with the primary care provider; maintenance of the registry; call in consultation with the psychiatric consultant
Available to deliver services face-to-face with an individual; has a continuous relationship with the individual and a collaborative, integrated relationship with the rest of the CoCM care team
Able to engage the individual outside of regular clinic hours as necessary to perform the behavioral health care manager’s duties
Does not include administrative or clerical staff; time spent in strictly administrative or clerical duties is not counted towards the time threshold to report the CoCM services

Psychiatric Consultant

A medical professional provider trained in psychiatry and qualified to prescribe the full range of medications, who is either employed by the same organization as the primary care provider or has a written agreement with the primary care provider to provide care management
Participates in regular review of clinical status of individuals receiving behavioral health services
Advises the primary care provider and behavioral health care manager about diagnosis; indicates options for resolving issues with the individual's adherence and tolerance of behavioral health treatment; makes adjustments to behavioral health treatment for the individuals who are not progressing; manages any negative interactions between the individual's behavioral health and medical treatments.
Can and should offer a referral for direct provision of psychiatric care when clinically indicated

GENERAL BEHAVIORAL HEALTH INTEGRATION (BHI)

General Behavioral Health Integration (BHI) are monthly services provided using BHI models of care other than Psychiatric Collaborative Care Management (CoCM) that similarly include “core” service elements such as systematic assessment and monitoring, care plan revision for individuals whose condition is not improving adequately, and a continuous relationship with a designated care team member. General BHI may be used to report models of care that do not involve a psychiatric consultant, nor a designated behavioral health care manager, although these providers may perform General BHI services.

General Behavioral Health Integration (BHI) refers to the integration of behavioral health with primary care as a strategy for improving outcomes for individuals with mental or behavioral health conditions.

References

Centers for Medicare & Medicaid Services (CMS). Federal Register. Medicare Program; CY 2021 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies.... [Federal Register Web site]. 12/28/2020. Available at: https://www.federalregister.gov/documents/2020/12/28/2020-26815/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part. Accessed August 31, 2026.

Centers for Medicare and Medicaid (CMS). Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services. December 2023. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Behavioral-Health-Integration-FAQs.pdf. Accessed August 31, 2026.

Simon, M. Fact sheet: Psychiatric collaborative Care Management Benefit in Medi-Cal. May 2021. https://www.chcf.org/wp-content/uploads/2021/05/PsychiatricCoCMBenefitMediCal.pdf. Accessed August 31, 2026.

Coding

CPT Procedure Code Number(s)

99492, 99493, 99494

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

99484

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

G0568 Initial psychiatric collaborative care management, 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 (list separately in addition to the advanced primary care management code)

G0569 Subsequent psychiatric collaborative care management, 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 discharge from active treatment (list separately in addition to advanced primary care management code)

G2214 Initial or subsequent psychiatric collaborative care management, first 30 minutes in a 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

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

G0323 Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)

G0570 Care management services for behavioral health conditions, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales, behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes, facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated member of the care team (list separately in addition to advanced primary care management code)

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From MA00.052b:

09/16/2026	This policy was reviewed and reissued in accordance with the Company's annual review process.
01/01/2026	This policy has been identified and updated for the HCPCS Code Updates effective 01/01/2026. The following procedure codes were added to the policy: G0568, G0569, G0570

Revisions From MA00.052a:

08/07/2024	The policy has been reviewed and reissued to communicate the Company's continuing position on Psychiatric Collaborative Care Management (CoCM) .
01/01/2024	Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.
01/01/2023	This policy has been identified and updated for the CPT/HCPCS Code Update effective 01/01/2023. The following procedure code was added to the policy: G0323

Revisions From MA00.052:

05/30/2022

This new policy has been developed to address the Psychiatric Collaborative Care Management (CoCM) services.

This new policy is effective 05/30/2022. The Company may provide reimbursement for CoCM services subsequent to review and approval of the primary care provider's CoCM program.

The Company is communicating the continuous coverage position on General Behavioral Health Integration services in this policy.

Version Effective Date:

1/1/2026

Version Issued Date:

1/2/2026

Version Reissued Date:

9/16/2026