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The Collaborative Care Model to Become a Benefit of Texas Medicaid June 1, 2022

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures, such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after June 1, 2022, the Collaborative Care Model (CoCM) will be a benefit of Texas Medicaid for persons of all ages who have a mental health or substance use condition, to include a preexisting or suspected mental health or substance use condition, as determined by the primary care provider (i.e., physician, physician assistant, or nurse practitioner.)

Overview of Services

The CoCM is a systematic approach to the treatment of behavioral health conditions (mental health or substance use) in primary care settings. The model integrates the services of behavioral health care managers (BHCMs) and psychiatric consultants with primary care provider oversight to proactively manage behavioral health conditions as chronic diseases.

CoCM services must be provided under the direction of the primary care provider and are benefits when provided in an office, outpatient hospital, inpatient hospital, skilled nursing facility or intermediate care facility, extended care facility, and “other location” settings.

CoCM services are individually delivered, time-based, monthly services that include the following:

  • Outreach and engagement
  • Completing an initial assessment
  • Developing an individualized and person-centered plan of care
  • Providing brief interventions and other focused treatments
  • Conducting weekly caseload reviews with the psychiatric consultant
  • Monitoring and tracking a person’s progress using a registry

Refer to: The Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Psychiatry and Behavioral Sciences Division of Population Health(link is external) for more information on registry requirements.

Claim Submission Guidelines

Only the primary care provider may submit claims for CoCM services. The BHCM and psychiatric consultant are reimbursed by the primary care provider via a contract, employment, or other arrangement.

Effective June 1, 2022, the primary care provider must submit the following procedure codes and meet the designated time thresholds to bill for monthly CoCM services in all settings:

Procedure Code

Time Thresholds

99492

Initial month: First 70 minutes of services accrued during the initial calendar month of BHCM activities, in consultation with the psychiatric consultant and directed by the primary care provider; billable at 36 minutes, time threshold is 36 to 85 minutes

99493

Subsequent months: First 60 minutes of services accrued during each subsequent calendar month of BHCM activities, in consultation with the psychiatric consultant and directed by the primary care provider; billable at 31 minutes, time threshold is 31 to 75 minutes

99494

Each additional 30 minutes of services accrued during the initial calendar month or subsequent calendar months of BHCM activities, in consultation with the psychiatric consultant and directed by the primary care provider; billable at 16 minutes beyond total time, up to 30 minutes

G2214

Initial or subsequent months: 30 minutes of services accrued during an initial calendar month or subsequent calendar months of BHCM activities, in consultation with the psychiatric consultant and directed by the primary care provider; billable at 16 minutes, time threshold is 16 to 30 minutes

Beginning June 1, 2022, additional CoCM benefit language will be published in the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook.

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