Behavioral Health and Medical Care Integration

The integration of behavioral health with primary care has become an effective approach for facilitating the coordination of care between physical health and behavioral health providers. Patients with serious medical conditions often have behavioral health complaints (e.g. depression, insomnia, substance use disorder) that can exacerbate their medical condition. Using the primary care setting as gateway for behavioral health and primary care needs has proven to be an effective way to address the needs of the whole person and improve health outcomes.

The Collaborative Care Model (CoCM)
Collaborative care is one model of behavioral health integration in which primary care is enhanced by adding regular behavioral health consultation and care management support for patients receiving behavioral health treatment. A patient-centered team led by the primary care provider consists of a behavioral health care manager, a behavioral health consultant and the patient. The team collaborates effectively using shared care plans that incorporate the patient goals.

CoCM services include an initial assessment, care planning with patient input and regular assessments of treatment adherence and clinical response, as well as treatment adjustments and referrals where needed. Anyone with a mental, behavioral health or psychiatric condition is eligible for CoCM services, as determined by their primary care provider.

Billing information for CoCM
Harvard Pilgrim reimburses CoCM when billed with the following CPT codes:

  • 99492 – Initial CoCM management. First 70 minutes in the first calendar month of behavioral health care manager activities.
  • 99493 – Subsequent CoCM management. First 60 minutes in a subsequent month of behavioral health care management activities.
  • 99494 – Add-on code for 99492 and 99493. Each additional 30 minutes in a calendar month.

Harvard Pilgrim also reimburses the following HCPCS code:

  • G2214 – Initial or subsequent CoCM management. First 30 minutes in a month of behavioral health care manager activities. To be used when some of the time requirements for the codes above are not met.

For billing questions for commercial members, please contact Harvard Pilgrim’s Provider Service Center at 800-708-4414; for billing questions for Medicare Advantage members, please call Harvard Pilgrim’s Medicare Advantage Provider Service Center at 888-609-0692.

Publication Information

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