Print Page   |   Contact Us
Community Search
Calendar

9/25/2020 » 9/27/2020
Fall 2020 CME Meeting & EXPO

News & Press: News Relating to Practice

APA has been successful in advocating for CMS coverage for payment

Tuesday, November 8, 2016  
Share |

APA has been successful in advocating for CMS coverage for payment for “Psychiatric Collaborative Care Management Services codes.”  CMS announced its FINAL Medicare Physician Fee Schedule rule that Medicare will begin coverage and reimbursement for “Psychiatric Collaborative Care Management Services” starting in 2017.  The final rule heeded several points made in APA comments in response to the preliminary rule earlier this year specifically the concern regarding the value of the psychiatric consultant services that are bundled in this code, which resulted in increased payment for these services. 

This is a VICTORY for APA, psychiatrists, primary care practices, and patients with mental health and substance use disorders.

These three new codes 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. 

This win was a joint effort between APA administration, members and the AIMS center.  I especially want to thank our Policy Reimbursement team – Becky Yowell, Sam Muszynski, and Eileen Carlson - Jeremy Musher, M.D., APA CPT and RUC advisor, and Jurgen Unitzer, M.D. from AIMS.

As you know, APA received a grant from CMS through its Transforming Clinical Practice Initiative to train psychiatrists and PCPs in the CoCM and to encourage systems to implement this evidence-based model.  We have trained over 800 psychiatrists in this model and are beginning to educate and train primary care practices this year.  Having payment for these services will only strengthen this initiative.  For more information about the TCPI, please visit www.psych.org/SAN.  

 


Sign In