Psychiatric Collaborative Care Model Form

Psychiatric Collaborative
Care Model Impact on Follow-Up After Hospitalization for Mental Illness
We are committed to the care and well-being of our members. We are also committed to working with you as a partner to develop the best possible treatment plans for all patients. Why is Collaborative Care Important? The integration of behavioral health (BH) and general medical services improves patient outcomes, saves money, and reduces stigma related to mental health. The Collaborative Care Model (CoCM) is a proven effective and efficient way to deliver integrated care.1 In 2022, the National Committee for Quality Assurance (NCQA) added psychiatric collaborative case management service codes 99492, 99493, 99494, and G0512 to help close the gap for the Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS Measure. What is CoCM?
Psychiatric services are provided under the direction of a treating primary care provider (PCP) for work performed by a BH care manager in consultation with a psychiatric consultant with prescribing authority. The treating PCP submits the claims for these services. The consulting psychiatrist and the care manager are then paid by the PCP though a contract, employment, or other arrangement. Document provided courtesy of Fidelis Care Revised 9/25/25 Psychiatric Collaborative Care Model

Core Principles of CoCM
• Patient-Centered Care: Primary and behavioral health providers collaborate effectively using shared
care plans. •

Population-Based Care: Patient care and progress is tracked in a registry to help identify needed psychiatric case reviews so no one “falls through the cracks.” • Treatment to Target: Progress is tracked with a measurement-based tool (i.e., Patient Health Questionnaire (PHQ-9)) to assess and actively change treatments until clinical goals are achieved. • Evidence-Based Care: Providers use evidence-based treatment modalities and tools for proven
effective care. • Accountable Care: Providers are accountable and reimbursed for quality of care and clinical outcomes, not just volume of care provided. Service Codes **CPT & HCPCS Coding for CoCM •

99492 - first 70 minutes in the first initial month • 99493 - first 60 minutes in any subsequent months • 99494 - each additional 30 minutes in any month • G0512 - FQHC or RHC locations

• Some service codes may not be included as a covered benefit for certain lines of business or products. Leverage provider resources and pre-authorization checker tool on Fidelis Care’s website to help determine covered benefits. Additional Support • American Psychiatric Association (APA) – www.psychiatry.org – 1 Collaborative Care Model • American Medical Association (AMA) –Compendium of behavioral health integration resources for physician practices – Experts on practical billing strategies for the collaborative care model Please view the Provider section of fideliscare.org for additional tools
  and local resources or contact a Provider Relations or Quality Improvement
  Specialist for assistance. References: AMA: www.ama-assn.org; APA: www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/learn; NCQA: www.ncqa.org/hedis/measures/initiation-and-engagement-of-alcohol-and-other-drug-abuse-or-dependence-treatment This document is an informational resource designed to assist licensed healthcare practitioners in caring for their patients.
  Healthcare practitioners should use their professional judgment in using the information provided. HEDIS® measures are not a
  substitute for the care provided by licensed healthcare practitioners and patients are urged to consult with their healthcare
  practitioner for appropriate treatment. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). 2024 ICD-10 Diagnosis Codes *CPT copyright 2024 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. Document provided courtesy of Fidelis Care Revised 9/25/25