This update applies to NC Medicaid Managed Care and NC Medicaid Direct.
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 is providing updated reimbursement guidance on coverage for collaborative care management. This change is effective retroactive to Dec. 1, 2022, to coincide with the date Medicaid added coverage for this service.
Collaborative care is a Medicaid allowable cost, but it is not considered a core service that can be billed using the T1015 HCPCS core service code. Collaborative care is excluded from the calculation of the Pay Per Service-Alternative Payment Method (PPS-APM) rate and is instead reimbursed outside of the PPS-APM. FQHC/RHC providers are expected to bill HCPCS code G0512 separately and will be reimbursed for collaborative care using the established fee schedule rate.
G0512 - Definition:
To qualify under the new guidelines, the care provided must adhere to the following:
- Be provided in an RHC or FQHC only, psychiatric collaborative care model (COCM)
- Consist of 60 minutes or more of clinical staff time for psychiatric COCM services directed by an RHC or FQHC practitioner - physician, nurse practitioner (NP), physician assistant (PA) or certified nurse manager (CNM) - and include services furnished by a behavioral health care manager in consultation with a psychiatric consultant, per calendar month
- Be rendered under the direction of a treating physician or advanced practice provider (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.
The latest updates can be found at: Updated Coverage for Psychiatric Collaborative Care Management Effective Dec. 1, 2022 | NC Medicaid (ncdhhs.gov)
For more information regarding psychiatric collaborative care management codes and requirements, refer to the 2022 Current Procedural Terminology manual published by the American Medical Association.
Contact:
NCTracks Call Center: 800-688-6696
Medicaid.ProviderReimbursement@dhhs.nc.gov (919-527-7699)