A study examined the reimbursement potential of the Collaborative Care Model (CoCM), an evidence-based practice for improving access and quality of behavioral health services in primary care, particularly for complex patient populations with co-occurring disorders. The research focused on CoCM applications for patients with opioid use disorder co-occurring with depression and/or post-traumatic stress disorder.
In 2017, the U.S. Centers for Medicare and Medicaid Services approved reimbursement for CoCM billing codes. The study analyzed 381 patients and 10 care managers across a pragmatic clinical trial, documenting 90,996 total intervention activity minutes in a care management registry. Using federal CoCM billing code rules and reimbursement rates as of 2024, researchers found that under ideal conditions where all billing codes could be used, a maximum of 56% of minutes would be billable, generating $91.61 reimbursement per hour of care management.
Reimbursement potential was considerably lower under more restrictive billing conditions and settings, resulting in $79.32 per hour. Most commonly, minutes were unbillable because they did not meet CoCM service requirements or exceeded the maximum billable time allowed for a month. Sensitivity analyses showed that reimbursement potential could drop notably lower in alternative scenarios, potentially ranging from $39.63 to $43.04 per hour with minimum plausible Medicaid billing rates.
The authors concluded that “continued attention is needed to align CoCM reimbursement potential with clinical needs to ensure feasibility and sustainability with complex patient populations.” The findings highlight gaps between what care managers document as necessary clinical work and what the current reimbursement structure supports.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.rand.org/pubs/external_publications/EP71302.html