Date: March 31, 2025
Attention: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
Effective date: March 1, 2025
Call to action: 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.
As a reminder, Collaborative Care Model 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.
How this impacts providers: 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.
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. 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.
- Is limited to one service per calendar month (initial or subsequent) during an episode of care for the same person from the same provider.
Reimbursement information
Procedure code G0512 may be reimbursed in addition to the FQHC or RHC encounter rate.
Prior Authorization Information
- In fee-for-service (FFS) Medicaid, 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 in FFS Medicaid 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.
Next step for Providers: FQHCs and RHCs should follow the guidance provided in this communication and inform their billing staff of these changes.
Resources:
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts
