Skip to main content

CoCM Services Provided by FQHC and RHC Providers

Last updated on

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after March 1, 2025, Texas Medicaid will add federally qualified health centers (FQHCs) and rural health clinics (RHCs) as provider types of Collaborative Care Model (CoCM) services using only procedure code G0512 for billing and reimbursement.

Statement of Benefits

CoCM services are benefits for persons of all ages who are enrolled in Texas Medicaid and who have a mental health or substance use condition to include a pre-existing or suspected mental health or substance use condition.

Initial or subsequent CoCM services using procedure code G0512 are activities that are provided by a behavioral health care manager (BHCM) and directed by an FQHC or RHC practitioner (physician, physician assistant, or nurse practitioner) to the person receiving CoCM services in the first calendar month or subsequent calendar month of services.

Reimbursement Criteria

Initial or subsequent CoCM services provided by an FQHC or RHC provider must include the following elements, and the FQHC or RHC practitioner or BHCM must document the elements in the electronic medical record or electronic health record:

  • Conducting outreach to and engagement with the person needing services
  • Completion of an initial assessment to include administration of a validated rating scale resulting in a person-centered plan of care
  • Entering information into the registry and tracking follow-up activities and progress through the registry with appropriate documentation
  • Participation in weekly caseload consultation meetings with the psychiatric consultant and modification of treatment, if needed
  • Providing evidenced-based brief interventions, such as motivational interviewing, problem-solving treatment, or other focused strategies
  • Tracking follow-up activities and progress of the person receiving services, through the registry and with appropriate documentation, using validated rating scales
  • Ongoing collaboration and coordination of the person’s care and treatment with the treating FQHC and RHC providers
  • Planning for relapse prevention as the person receiving services prepares for discharge from services

FQHCs and RHCs must use procedure code G0512 to bill for CoCM services delivered in the initial calendar month or any subsequent calendar month. Procedure code G0512 is restricted to use by FQHCs and RHCs. Therefore, procedure code G0512 will be denied if billed by any other provider type.

Note: Procedure code G0512 may be reimbursed in addition to the FQHC or RHC encounter rate.

Prior Authorization

Prior authorization is not required for the first six calendar months (the initial month and five subsequent months) of CoCM services to include CoCM services provided by an FQHC or RHC provider.

Prior authorization is required for an additional six calendar months (beyond the first six calendar months) of CoCM services to include CoCM services provided by an FQHC or RHC provider.

Limitations

Procedure code G0512 requires a minimum of 60 minutes of CoCM services to be furnished within each calendar month of services (initial or subsequent). Administrative and clerical duties do not count towards the time threshold.

Procedure code G0512 is limited to one service per calendar month (initial or subsequent) during an episode of care for the same person from the same provider.

Add-on procedure code 99494 may not be submitted with procedure code G0512.

Refer to the current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.3, for more information on CoCM services to include medical necessity criteria and authorization and billing and reimbursement requirements.

For more information, call the TMHP Contact Center at 800-925-9126.