When Billing Codes Fall Short: Unbillable Time in Collaborative Care for Co-occurring Opioid Use and Mental Health Conditions

OBJECTIVE: Considerable time spent on delivering the collaborative care model (CoCM) for patients with co-occurring opioid use and mental health conditions is not billable under relevant billing codes for Medicare or Medicaid behavioral health integration. In this follow-up study, the authors explored associations between patients' characteristics and the likelihood of receiving unbillable services. METHODS: Billable time was estimated by applying billing code rules to documentation of CoCM delivery from a clinical trial (N=381 patients). Multivariate logistic regressions revealed patient characteristics associated with receiving >15 minutes in ≥1 months of unbillable outreach before CoCM engagement or care time that exceeded code maxima. RESULTS: Overall, 43% of the patients received unbillable outreach, and 59% exceeded billable time. Health system, age, stimulant use, and worry about housing were significantly or marginally associated with exceeding billable time; health system also predicted unbillable outreach. CONCLUSIONS: Policymakers should consider modifying CoCM billing codes to adequately reimburse efforts to engage and serve this complex patient population.