More about Collaborative Care

We provide technical assistance and expertise for implementing CoCM in clinics and healthcare systems. CoCM is not a one size fits all solution, so we work with health care systems to implement effective, measurement based care approaches to treating mental health issues. If you would like to reach out to us for technical assistance, please do so here.

CoCM is reimbursed through specific CPT® codes for psychiatric collaborative care management services (99492, 99493, 99494 and G2214). CoCM billing is considered “incident to” billing, so these behavioral health services are billed under the primary care clinic and paid for by the patient’s general medical benefits. Questions about sustainability are beyond the scope of this FAQ. However clinics who eventually reach financial sustainability with CoCM usually have a broad payor mix, and using the CoCM codes to cover the mix of case-management and medication management services provided through CoCM.  

The American Psychiatric Association has helpful information dedicated to the reimbursement of CoCM services which includes details about the CPT codes and which insurance companies cover CoCM services.  

CoCM and PCBH are different yet complementary models and can work together in the same clinical setting. Both involve co-located behavioral health professionals and warm hand-offs from the PCP. PCBH usually limits treatment to about 6 evidence based therapy interventions, while CoCM begins with the development of a psychiatric diagnosis and treatment plan, using measurement based care, treatment to target, and also includes medication management. Individuals remain in CoCM treatment for an average of 4-6 months and are discharged with a relapse prevention plan. CoCM has its own reimbursement codes, while PCBH implementation depends on psychotherapy codes. The American Psychological Association has an excellent fact sheet comparing the two models.  

Psychiatrists and psychiatric providers are an essential component of CoCM. On the most basic level, they are required to act as the psychiatric consultant who works directly with the BHCM to review patient information within the registry and make psychiatric recommendations for the PCP to implement. CoCM is a form of workplace extension, and through the population-based approach, 2-4 hours of psychiatric consultant time can treat a caseload of 60-100 patients depending on the complexity. In addition to acting as psychiatric consultants, psychiatrists have the systems based knowledge and policy background to advocate for CoCM to expand the reach of evidence based mental health treatment for patients within PCP practices. To support psychiatrist advocacy of CoCM, the American Psychiatric Association along with the AIMS Center at the University of Washington, has spearheaded major training initiatives to address all aspects of CoCM from PCP and psychiatric consultant training to essential informaiton about billing and financial sustainability.

Over the past 20 years, the use of CoCM has been utilized in a variety of psychiatric conditions including substance use disorders. CoCM is most used to treat major depressive disorder and generalized anxiety as was first established in the IMPACT trial published in JAMA in 2002. Other psychiatric diagnoses include substance use disorders including opioid use disorder and alcohol use disorder; bipolar disorder and PTSD, perinatal mental health disorders, and pediatric populations.  

The Dell Medical School Center for Collaborative Care Behavioral Health and Meadows Mental Health Policy Institute collaborated on the Pediatric and Adolescent Collaborative Care Roundtable to gain insight into real-world implementation solutions for pediatric collaborative care.  

At its core, CoCM is a team based integrated behavioral health model which is centered on measurement-based care and treatment to target so patient outcomes are monitored for response, remission, or relapse. The registry is the tool used to track patient outcomes and used by the behavioral health care manager and psychiatric consultant during their consultation meetings so that high acuity patients and those not responding to treatment are prioritized in discussions. The registry tracks patient outcomes ensuring CoCM is also accountable care and a good option for healthcare organizations seeking value-based care.  

It’s best to think about CoCM as a transformative change to a healthcare clinic or system, and not just an integrated behavioral health program. As such, implementing CoCM requires a team-based approach, starting with a behavioral health champion within the clinic, buy-in from the primary care providers, clinical operations leaders, and input from other supports such as IT and billing and revenue experts. See the Collaborative Care Model Transformation Team Tool to understand the full scope of who is involved in implementation.  

A great place to start to learn about implementation is the APA page on trainings for the CoCM model or the AIMS Center website.

CoCM incorporates principles of workforce expansion and population health, through the use of a Behavioral Health Care manager, and a psychiatric consultant who utilize on a registry to efficiently and accurately review patient symptoms and outcomes. This model extends the reach of psychiatric expertise. In usual outpatient care, a psychiatrist would require 25 hours per week to carry a 300-patient case load but in CoCM this can be done through consultation in 2-4 hours per week. One full time psychiatrist could help treat 4800 patients through CoCM. 

AIMS Center General FAQ 

For detailed information about billing and how and which services can be rendered under the CoCM CPT codes, see the AIMS Center’s Basic Coding for Integrated Behavioral Health Care.