Friday, July 8, 2016

CMS Announces Medicare Coverage of Psychiatric Consultations in Collaborative Care

Medicare will begin reimbursement next year for collaborative care services, according to an announcement by the Centers for Medicare and Medicaid Services (CMS).

CMS, in its proposed Medicare Physician Fee Schedule rule, has included coverage for “Psychiatric Collaborative Care Management Services.” The coding for those services will support payments to psychiatrists for consultative services they provide to primary care physicians in the collaborative care model (CoCM). 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.

“This is a huge win for APA, psychiatrists, as well as patients with mental health and substance use disorders,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “The APA administration is in the process of reviewing the rule for more specifics regarding these new codes and other provisions of the proposed rule.” 

After conducting its review, which will include an analysis of work values associated with the coding, APA will submit comments to CMS.

In the CoCM, the primary health care provider employs a behavioral health care manager to provide ongoing care management for a caseload of patients with diagnosed mental health or substance use disorders. The psychiatrist provides the primary care practice with expert advice and consultation through regular case review and recommendations for treatment and medication adjustments; in especially difficult cases, the psychiatrist may also provide direct treatment.

The codes included in the CMS announcement for adoption in 2017 are similar to the “Psychiatric Collaborative Care Management” codes that the CPT® Editorial Panel approved for use starting in 2018. The CPT coding proposal was brought by APA, with the assistance and participation of several other medical specialty societies, including the American Academy of Child and Adolescent Psychiatry, the American Academy of Family Physicians, and the American College of Physicians, among others.

Importantly, APA received a grant from CMS through its Transforming Clinical Practice Initiative to train psychiatrists and primary care physicians in the CoCM and to encourage systems to implement this evidence-based model. Training will be provided online an at APA meetings, including the upcoming IPS: The Mental Health Services Conference in Washington, D.C., in October. Read more about the TCPI on APA's website.

For detailed coverage of the CMS proposed rule and additional information about the collaborative care model, see an upcoming edition of Psychiatric News.


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