Thursday, November 3, 2016

Medicare Final Rule Increases Payment for Psychiatric Consultation in Collaborative Care

The Centers for Medicare and Medicaid Services (CMS) last night released a final rule on the 2017 Medicare Fee Schedule including the 2017 fee for Psychiatric Collaborative Care Management Services, with improved payment amounts over those included in the proposed rule issued in August.

The coding for these services will support payments to psychiatrists for consultative services they provide to primary care physicians 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 weblog post, CMS Acting Administrator Andy Slavitt wrote that “these changes will result in an estimated $140 million in additional funding in 2017 to physicians and practitioners providing these services.”

Initial analysis of the rule by APA staff indicates that the Obama Administration 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. “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.

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 say that while this work value is an improvement, it is difficult to know whether it will be sufficient over the long term. 

“Establishing a sustainable payment for psychiatric participation in collaborative care is vital to making this important new model of care successful,” Levin told Psychiatric News. “We look forward to continuing to work with  Congress and the administration around this important issue.”

The new code and work value should help underscore the importance of 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. 

Look for more information about the fee schedule in an upcoming edition of Psychiatric News. More information about the TCPI and APA's collaborative care training for psychiatrists is posted at


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