In 2018, NC Medicaid launched the first codes to reimburse primary care for Collaborative Care Management (CoCM), an evidence-based model of care geared to those with mild- to moderate-behavioral health needs designed to improve access to psychiatry services and maintain continuity of care. Despite coverage, the utilization across the state is well below the desired rate for a variety of reasons.
In January of 2022, a multidisciplinary, multi-payer team of leaders across North Carolina launched the Collaborative Care Consortium to redesign and relaunch this model of care. The goal is to provide training and tracking resources at low or no cost to practices, streamline clinical coverage across all payers and drive continuous improvement and uptake in this model of care.
This bulletin highlights the changes to definitions and coverage, provides an overview of significant rate increases now in effect, announces partnerships and no cost resources for Medicaid providers, and highlights how the NCDHHS will monitor and track measures of integrated care.
Updated Clinical Coverage for Psychiatric Collaborative Care Management
HISTORICAL: North Carolina Medicaid added coverage for the following evaluation and management codes effective Oct. 1, 2018
99492 – Initial psychiatric collaborative care management, first 70 minutes in the first calendar month
99493 – Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities
99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month
NEW in MARCH 2022: NC Medicaid added coverage for HCPCS Code G2214 effective March 1, 2022
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 healthcare professional
NEW in DECEMBER 2022: NC Medicaid added coverage for HCPCS Code G0512 for RHCs and FQHCs effective Dec. 1, 2022
G0512 - Rural health clinic (RHC) or federally qualified health center (FQHC) only, psychiatric collaborative care model, (psychiatric COCM) 60 minutes or more of clinical staff time for psychiatric CoCM services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month.
Updated Definitions
To align with Medicare and to expand access to this model of care given ongoing workforce challenges, NC Medicaid has clarified and updated who could serve as a Behavioral Health Care Manager to include RNs as well as non-licensed, but trained, behavioral health staff who are appropriate to provide care management services.
Psychiatric Collaborative Care Management
Services must be rendered under the direction of a treating physician or non-physician practitioner (NPP) in a primary care setting. These services are rendered when a beneficiary has a diagnosed psychiatric disorder and requires assessment, care planning, and provision of brief interventions. These beneficiaries may require assistance engaging in treatment or further assessment prior to being referred to a psychiatric care setting.
Behavioral Health Care Manager
Master’s or doctoral-level prepared clinical staff member, licensed staff member with behavioral health training (e.g., Licensed Clinical Mental Health Counselor/Professional Counselor, Licensed Marriage and Family Therapist, Licensed Social Worker, Registered Nurse, Nurse Practitioner, Licensed Psychologist, Masters-level licensure candidate/trainee licensed clinical social worker(LCSW-A) or other designated and appropriately trained member of the care team who provides care management services and assessment of beneficiary needs.
The Behavioral Health Care Manager consults with the psychiatric consultant and administers validated rating scales, develops care plans, provides brief interventions, collaborates with other members of the treatment team, and maintains a beneficiary registry. Services are provided face-to-face and non-face-to-face and psychiatric consultation is provided minimally on a regular and appropriate basis.
Psychiatric Consultant
Refers to the consulting physician or advanced practice provider (APP), trained in psychiatry or behavioral health with full prescribing authority. The consultant advises and makes recommendations and referrals as needed for psychiatric and medical care. These recommendations and referrals are communicated to the treating provider through the behavioral health care manager. The psychiatric consultant typically does not see the beneficiary or prescribe medications. Please note any prescribing provider must be enrolled in NC Medicaid to write prescriptions for Medicaid beneficiaries.
For more information on the Clinical Coverage Collaborative Care Updates, please see the Updated Coverage for Psychiatric Collaborative Care Management Effective Dec. 1, 2022 bulletin.
Rate Increase for Psychiatric Collaborative Care Management Effective Dec. 1, 2022
In response to provider requests and to better align with the Centers for Medicare and Medicaid Services (CMS) on reimbursement for behavioral health integration in primary care settings, NC Medicaid has increased the rates for Psychiatric Collaborative Care codes 99492, 99493 and 99494. NC Medicaid’s updated coverage for collaborative care management was previously published Nov. 21, 2022. Notably, the reimbursement rate has now increased to 120% of Medicare rates to demonstrate the state’s commitment to improving access to high-quality behavioral health services through Medicaid.
Claims submitted prior to rate implementation in NC Tracks on Dec. 13, 2022, will be systematically processed. No provider action is required.
Psychiatric collaborative care management services must be rendered under the direction of a treating physician or advanced practice provider (APP) (e.g., Nurse Practitioner/Physician Assistant (NP/PA) in a primary care setting. These services are rendered when a beneficiary has a diagnosed psychiatric disorder and requires assessment, care planning and provision of brief interventions. These beneficiaries may require assistance engaging in treatment or further assessment prior to being referred to a psychiatric care setting.
Rates for Psychiatric Collaborative Care
| Procedure Code | Procedure Code Description | Facility Rate | Non-Facility Rate |
|---|---|---|---|
| 99492 | Initial psychiatric collaborative care management, first 70 minutes in the first calendar month | $109.94 | $176.23 |
| 99493 | Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities | $120.82 | $171.30 |
| 99494 | Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month | $49.24 | $73.14 |
| 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 healthcare professional. | $32.70 | $50.93 |
| G0512 | Rural health clinic (RHC) or federally qualified health center (FQHC) only, psychiatric collaborative care model, (psychiatric COCM) 60 minutes or more of clinical staff time for psychiatric CoCM services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month | $124.53 | $124.53 |
Access to Patient Registry through Community Care of North Carolina
NC Medicaid is contracting with Community Care of North Carolina (CCNC) to host the collaborative care registry which is a key component of the CoCM model. CCNC is partnering with the Advancing Integrated Mental Health Solutions (AIMS) Center in Washington state to provide the registry to primary care practices. NC Medicaid will support the registry cost for up to three years for practices that participate as AMH Tier 2 or 3 primary care providers.
Practices that are engaged with North Carolina Area Health Education Centers (NC AHEC) coaches for technical assistance (see below) will be referred to CCNC who will then coordinate CoCM registry setup for the practice. NC AHEC coaches will assist the practice in the optimal use of the CoCM registry.
Practice Supports at No Cost through NC AHEC
Through a partnership with NC Medicaid, NC AHEC is providing practice support to primary care practices and professional associations interested in learning more about CoCM or seeking assistance with implementation, workflows, billing/coding, Behavioral Health Care Manager (BHCM) and psychiatric consultant recruitment, the AIMS/CCNC caseload tracker adoption, etc.
NC AHEC is also offering educational programming on CoCM topics of interest to providers and staff. This work is completed in partnership with CoCM subject matter experts through AIMS and statewide providers with expertise in the model. More information can be found on the NC AHEC Collaborative Care Model (CoCM) webpage.
Association Supports for Implementing Collaborative Care Model
To promote adoption of CoCM, medical associations such as the NC Academy of Family Physicians (NCAFP), NC Pediatric Society (NCPS) and NC Psychiatric Association (NCPA) are identifying CoCM champions among their members and promoting the training, coaching, practice supports and tools being developed and offered by NC AHEC and CCNC in their publications and meetings.
These groups have collaborated to develop:
- A contract template for practices to use in contracting with psychiatric consultants,
- a matching process so that primary care provider (PCP) practices interested in adopting the model can connect with psychiatric consultants trained in the model and suited for their practices, and
- free CoCM resources and online training for PCPs, BHCMs and psychiatric consultants.
Measuring Integration of Physical and Behavioral Health: The Integrated Care Dashboard
NC Medicaid has created an integrated care dashboard which measures key indicators of integrated care in both Standard and Tailored Plans by focusing on high quality provision of both physical and mental health services. For example, one of the measures on this dashboard is the provision of CoCM across the state in medical homes and will track the change over time and access as a function of geography, race and ethnicity. The dashboard will be shared in the near future on the NC Medicaid Quality website.
Additional measures (that include physical health and behavioral health indicators for both plan types) include:
- Primary care visit within 12 months
- Maternal depression screen rate
- Beneficiaries receiving collaborative care
- Behavioral health emergency department use
- Use of psychosocial services in first year of medication-assisted treatment for substance use disorders (SUD)
- Community-based SUD visits that had a PCP visit in the 30 days after
- Behavioral health service usage in a PCP setting
- Metabolic monitoring for children and adolescents on antipsychotics (metabolic testing)
- Asthma Admission Rate (per 100k member-months)
- Urinary Tract Admission Rate (per 100k member-months)
- Diabetes Short-term Complications Admission Rate (per 100k member-months)
- COPD or Asthma in Older Adults Admission Rate (per 100k member-months)