CMS Finalizes Code for Collaborative Care

The Centers for Medicare and Medicaid Services (CMS) last month released a final rule on the 2017 Medicare Fee Schedule that includes a CPT code and a fee for Psychiatric Collaborative Care Management Services. The fee is higher than the amount stated in the proposed rule issued last August.

The code will be used to reimburse primary care physicians for services that psychiatrists provide in the collaborative care model. The model was developed by the late Wayne Katon, M.D., and Jürgen Unützer, M.D., M.P.H., at the AIMS Center of the University of Washington. It is the only evidence-based model of its kind and has been proven effective in more than 80 randomized, controlled trials. The AIMS Center has been an invaluable ally to APA in advocating for reimbursement coding for collaborative care.

In a blog post, CMS Acting Administrator Andy Slavitt, M.B.A., noted that the psychiatric collaborative care model “supports mental and behavioral health through a team-based, coordinated approach involving a psychiatric consultant, a behavioral health care manager, and the primary care clinician” extending beyond the scope of an office visit.

“This care model has been shown to improve behavioral health outcomes for patients and save money,” Slavitt stated. “Payment for care using this model will help address one of the health system’s major challenges—access for behavioral and mental health care. For anyone who has struggled to gain access to behavioral health care for themselves or a loved one, the importance of these services cannot be overestimated.”

Initial analysis of the rule by APA staff indicates that CMS heeded several points that APA made earlier this year in its response to the proposed rule, which led to the higher payment in the final rule. In comments submitted to CMS in August, Levin noted that the CMS proposal to crosswalk the work of the psychiatric consultant to CPT code 90836 (Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service) was not appropriate and resulted in a work value that Levin said was not sustainable.

The new work value is based on a crosswalk to a level three evaluation and management service. APA staff said that while this work value is an improvement, it is difficult to know whether it will be sufficient over the long term.

“We are grateful to the administration for acting on recommendations we provided to address what we believe was a significant undervaluing in the proposed rule of the work a psychiatrist performs in the collaborative care model,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “Establishing a sustainable payment for psychiatric participation in collaborative care is vital to making this important new model of care successful. We look forward to continuing to work with Congress and the administration around this important issue.”

The new code and work value underscore the importance of psychiatrists’ participation in the CMS Transforming Clinical Practice Initiative (TCPI). APA is a Support and Alignment Network within this initiative and to date has trained over 800 psychiatrists in the collaborative care model. APA will begin to train primary care practitioners later this year.

In the August letter to Slavitt, Levin called the new collaborative care code “a huge advancement in health policy.”

“For patients with common behavioral disorders who are treated in primary care, the collaborative care model (CoCM) maximizes the effectiveness of current behavioral health treatments by ensuring that patients are identified, treated, and monitored proactively, with clinical guidance provided by a qualified psychiatric consultant,” Levin said. “In this model, primary care providers receive extensive support from a team that includes a trained behavioral health care manager and a psychiatric consultant. Patients benefit from the heightened benefits of a collaborative, team-based approach that applies well-established principles of population-based behavioral health care and employs specific behavioral health expertise.” ■

The CMS Final Rule can be accessed here. The text of APA’s August letter to CMS is available here. More information about the TCPI and APA’s collaborative care training for psychiatrists is here.