This is an exclusive BHB+ story.
Eight years after psychiatric collaborative care management codes were formally introduced, provider adoption still lags.
It should come as no surprise, industry insiders told Behavioral Health Business, especially given early literature around its rollout predicted friction. The initial arguments in favor of establishing Psychiatric collaborative care management (CoCM) codes noted that collaborative care could not successfully scale in behavioral health under fee-for-service models because a lot of care occurred outside of traditional visit structures.
While past documentation notes that the codes were intended “to capture revenue for services outside of face-to-face visits,” and support broader integration of behavioral healthcare into primary care settings, in 2026, that is still not a robust reality.
A 2021 claims study identified an eightfold increase in CoCM code use as well as other behavioral health integration billing codes among clinicians between 2017 and 2018 after the initial rollout. However, it simultaneously noted that denied services were a barrier and overall adoption remained low at the time. That trend has continued through to 2026.
“It’s not that providers don’t believe in collaborative care, it’s that billing and operational complexity is really high,” Sherry Rais, co-founder and CEO of Enthea, told BHB. “We’re asking primary care practices to track time super meticulously and manage psychiatric consultation workflows and navigate reimbursement rules that are still evolving constantly, and so for many practices, especially the smaller ones, that’s just not sustainable.”
Enthea is a third-party administrator of health insurance plans and offers employee benefit plans that cover mental health treatments like psychedelic-assisted therapies and other interventional psychiatry methods.
Broadly, Rais noted, fee-for-service reimbursement models still fit direct visits better than team-based work.
That applies to CPT codes for team-based care beyond collaborative care models, too. Team-based models stretch across other initiatives in the behavioral health sector as well, including pediatric telehealth psychiatry, mobile crisis teams, opioid health homes and certified community behavioral health clinics (CCBHCs). The primary issues with team-based behavioral health models seem to revolve around two areas that connect back to fee-for-service reimbursement, according to a 2023 study: the lack of reimbursement for team-based activities and the lack of sustainable reimbursement for specific provider types, such as peer support specialists, for example.
“The codes are for time-based billing, so instead of paying for the time or per visit, it’s for the entire treatment for that month,” Debbie Witchey, president and CEO of the Association for Behavioral Health and Wellness (ABHW), told BHB. “That is very different. But also, it’s a team-based approach, so it’s not just one provider who is billing and getting reimbursed. That’s another challenge for smaller practices that don’t really have the infrastructure for team-based care. It makes it hard for them to bill.”
The ABHW is a membership organization for payers that manage behavioral health insurance benefits.
All of that, Witchey said, contributes to the lack of adoption across the field of CoCM codes. The same 2023 study found that payer fragmentation is often an additional hurdle to team-based code adoption.
“Coverage is all over the map,” Pankhuri Sharma, a strategy and operations leader at Humana, told BHB. “As of 2022, fewer than half of state Medicaid programs covered CoCM for adults in fee-for-service, so even motivated practices can’t always build a sustainable business case. The startup costs alone can be quite high, and practices would need to invest before they have even seen a single patient under the model.”
Humana is a for-profit healthcare services provider and insurance company that specializes in Medicare Advantage plans.
Sharma explained that, typically, value-based arrangements between payers and providers can “provide the right ecosystem for this initiative” because incentives on both ends are aligned. However, across behavioral health, value-based care contracts are not as common as fee-for-service agreements, and they’re more challenging to obtain since the field lacks many common data points or quality standards as physical healthcare.
While the CoCM model itself is strong, it does not necessarily mean it is easy to implement, Sharma said.
“The workforce piece is one of the biggest impediments,” Sharma said. “Finding and training a qualified behavioral health care manager takes months in the best of circumstances, and we’re asking practices to do this in a market where behavioral health clinicians are incredibly hard to come by.”
Staffing shortages are anticipated to persist across the behavioral health sector nationwide, with the Health Resources and Services Administration (HRSA) projecting a shortage of 99,780 mental health counselors, 99,840 psychologists, 43,810 psychiatrists and 77,050 addiction counselors by 2038.
Not only are the persistent shortages a problem with CoCM code adoption, it’s also a training issue, Witchey added.
“The staffing issues, like, do you actually have a psychiatric provider to include in your model? All the kinds of fragmented care issues that we have in other parts of healthcare delivery make it hard to get collaborative care off the ground,” Witchey said. “There’s training that has to happen for the workforce to deliver care in a different model.”
Some payers like Elevance and Centene provide training to providers to help with the lift, but Witchey noted that not all providers realize the extent to which health plans are willing to invest and provide technical training to help them set up these models to begin with.
One thing that could ease the burden is expanding the role of care managers so they could engage in the necessary ways to aid CoCM models in getting off the ground could help adoption, Rais said. Still though, there needs to be a renewed focus from payers and providers alike on simplifying reimbursement and care models so that collaborative care is effective and scalable.
“One thing that I think is important is looking at actual outcomes,” Rais said. “The CoCM rollout showed us that [piece] should be integrating more, but it probably also exposed how hard it is to scale legacy systems that don’t have the outcomes that we’re looking for.”
As the field increasingly shifts from a focus on broadening access toward proving outcomes, Witchey feels that collaborative care and CoCM adoption will come as the business case for building its infrastructure around value-based care also grows. As the field moves more in this direction, the benefit for practices to invest in the infrastructure necessary to support collaborative care will be that it also sets them up to move into value-based arrangements, and the two will go hand-in-hand.
“You saw [this] in physical health, when value-based care was first starting out and accountable care organizations were starting out… you needed really two different structures,” Witchey said. “I think we’re at a similar point here with collaborative care models.”