Collaborative Care Model (CoCM) Initiative
Effective January 1, 2024, CareSource is providing reimbursement for a model of integrated behavioral health care known as the Collaborative Care Model (CoCM). This model is in effect for both the Hoosier Healthwise (HHW) plan and the Healthy Indiana Plan (HIP).
The CoCM uses an interdisciplinary team-based approach to provide evidence-based treatment of behavioral health conditions such as depression, anxiety, and substance use disorder. The CoCM allows for a comprehensive team approach in treating common mental health conditions by incorporating behavioral health professionals into the team. Behavioral health conditions such as: depression, anxiety, PTSD, alcohol and/or substance use disorders are some of the most common and disabling disorders addressed by the model.
The CoCM team is led by the primary medical provider (PMP), supported by a behavioral health care manager and a psychiatric consultant. The team implements a care plan based on evidence-based practice guidelines and focuses particular attention on patients not meeting their clinical goals.
What providers are eligible for the CoCM?
Primary care offices are eligible to incorporate the CoCM model into their practices. The PMP then leads the CoCM team, which include: behavioral health care managers, psychiatrists, and may also include other mental health professionals.
What qualifications are required for the behavioral health care manager role?
The behavioral health care manager is a designated team member of the CoCM team with formal education or specialized training in behavioral health (e.g., social work, nursing, or psychology), but Medicare does not specify a minimum education requirement. The behavioral health care manager must be available to provide services face to face with the patient and have an integrated and collaborative relationship with the rest of the care team. The behavioral health care manager must also be able to engage the patient outside of the regular clinic hours, if needed.
Is there a specific enrollment process for providers?
No, CareSource will identify eligible providers.
Does this service require prior authorization?
No, there are no prior authorization requirements for CoCM services.
What codes are covered for services furnished using the CoCM?
| Code | Definition | BH Care Manager or Clinical Staff Threshold Time | Billing Practitioner Time |
|---|---|---|---|
CoCM First Month CPT 99492 | Initial psychiatric collaborative care management | First 70 minutes in the first calendar month | 30 minutes |
CoCM Subsequent Months CPT 99493 | Subsequent psychiatric collaborative care management | First 60 minutes in a subsequent month of behavioral health care manager activities | 26 minutes |
Add-On CoCM (Any month) CPT 99494 | Initial or subsequent psychiatric collaborative care management | Each additional 30 minutes in a calendar month | 13 minutes |
Added New Code HCPCS 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 | Usual work for the visit code |
Please note: These codes should be billed on a HCFA 1500 form and on a claim that does not contain other service codes outside of these four codes. Billing these codes does not guarantee payment. Providers should refer to billing guidance from Centers for Medicare & Medicaid Services (CMS) prior to claims submissions.
What place of service (POS) should be reported on the professional claim?
CareSource will provide reimbursement for services provided in both facility and non-facility settings. These services should be submitted on a professional claim. The billing practitioner should report the POS for the location where he or she would ordinarily provide face to face care to the patient.
Where can providers direct questions?
Providers can email questions or interest in participating in the CoCM to the Behavioral Health Clinical inbox at: Indiana_BH@caresource.com.