New Medicare Payment Option for Behavioral Health Integration

Medicare rang in the new year with four new codes to reimburse primary care teams for behavioral health services. According to an article that appeared in the New England Journal of Medicine on February 2, 2017, three of the codes support services using the Collaborative Care Model (CoCM) and the fourth allows for services provided under other behavioral health care models. The codes are meant to facilitate access and integration of behavioral health services such as care management and psychiatric consultation for the primary care team. They focus on improving quality of care and patient satisfaction and could play a pivotal role in supporting interdisciplinary collaboration in primary health care.

The most immediate impact of the codes may be felt by physicians already providing these services for common mental health conditions such as depression and anxiety; however, these codes could potentially be applied to care coordination services for other behavioral health conditions such as those supporting integration of substance use disorder treatment and primary care. Yuhua Bao, PhD, Associate Professor of Healthcare Policy & Research at Weill Cornell Medicine and former CHERISH pilot award recipient, is an expert in payment policy for behavioral health conditions. She comments that “these new reimbursement codes recognize that primary care practices need additional resources to coordinate behavioral health care services in an evidence-based way, and that the initial month requires more intensive services.”

The new codes include reimbursement for time delivering CoCM services, approximately $140 for 70 minutes per beneficiary for the first month; approximately $125 for 60 minutes per beneficiary for subsequent months; and for all months, approximately $65 for each additional 30 minutes per beneficiary. For time delivering other behavioral health integrations services, the new codes reimburse approximately $48 for at least 20 minutes of services per beneficiary per month.