Establish a consultation fee G-code
Recommendation
The Centers for Medicare and Medicaid Services (CMS) should establish a new G-code for a “consultation” fee. Such a code is critical to integrating mental health and substance use disorder (MH/SUD) care into primary care settings by supporting consultative relationships with a psychiatric professional, who would receive a supplemental G-code for providing decision supports.[1]
Background/summary
In 2017, the Centers for Medicare and Medicaid Services (CMS) began paying physicians and non-physician practitioners separately for supplying patients with Behavioral Health Integrated Services (BHI).[2] These services involve a closer partnership between treating physicians and mental or behavioral health professionals, which has proven beneficial to patients and has evolved into the Collaborative Care Model (CoCM). CMS uses G-codes to assess and address functional limitations in patients, including difficulty seeing, hearing, mobility, communication, cognition, and self-care.[3][4] These billing codes include approvals for reimbursement of services using CoCM approaches, but there is currently no appropriate billing code for physicians seeking a psychiatric professional for ad-hoc consultations.[1][5] CMS should establish a new G-code for a “consultation” fee that will empower physicians to more readily seek psychiatric consultations and foster more CoCM-centered care.[1] The CoCM has been demonstrated effective by more than 90 randomized-controlled trials and can help to more effectively utilize our limited MH/SUD provider capacity.[6]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Updated October 2017.
2. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Behavioral Health Integration Services. Last Updated March 2021.
3. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Functional Reporting. Last Updated December 2021.
4. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Functional Limitations. Last Updated June 26, 2023.
5. The Kennedy Forum. Quality and Parity: New Payment Models for Behavioral Health. Last Updated September 8, 2017.
6. The University of Washington AIMS Center. Collaborative care. (n.d.)