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Medicare will begin reimbursement of psychiatric collaborative care management services in 2017

CMS announced late this week in its proposed Medicare Physician Fee Schedule rule that Medicare plans will begin coverage and reimbursement for “Psychiatric Collaborative Care Management Services” starting in 2017.   

This is a HUGE win for APA, psychiatrists, as well as patients with mental health and substance use disorders.

“Psychiatric Collaborative Care Management Services” are designed to improve care for the majority of patients who receive treatment for mental health and substance use disorders through their primary care provider. These services are based upon the “Collaborative Care Model” (CoCM) developed by the late Wayne Katon, M.D. and Jurgen Unitzer, M.D., at the AIMS Center of the University of Washington. This is the only evidence-based model of its kind and was proven effective in more than 80 randomized control trials.

Under these services (and the CoCM), the primary health care provider employs a behavioral health care manager to provide ongoing care management for a caseload of patients with diagnosed mental health or substance use disorders. A consulting psychiatrist provides the primary care practice with the benefit of his or her specialized expertise in treating such conditions, through regular case review and recommendations for treatment, medication adjustments, the need for specialty care, etc.  

The APA administration is in the process of reviewing the rule for more specifics regarding these new codes and other provisions of the proposed rule. A final rule is expected to be issued in November. 

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APA Urges Creation of Payment Codes Specific to Collaborative Care Model

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