TY - JOUR
AU - R. L. Weir
AU - L. Pak
AU - C. M. McCullough
AU - G. M. Hindmarch
AU - S. J. Mendon-Plasek
AU - B. A. Griffin
AU - K. E. Watkins
AU - A. R. Dopp
A1 - 
AB - 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.
AD - RAND, Santa Monica, CA.; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles.
AN - 42014956
BT - Psychiatr Serv
C5 - Financing & Sustainability; Opioids & Substance Use
CP - 8
DA - 08/2026
DO - 10.1176/appi.ps.20250715
DP - NLM
ET - 20260422
IS - 8
JF - Psychiatr Serv
LA - eng
N2 - 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.
PY - 2026
SN - 1075-2730
SP - 767
EP - 771+
ST - When Billing Codes Fall Short: Unbillable Time in Collaborative Care for Co-occurring Opioid Use and Mental Health Conditions
T1 - When Billing Codes Fall Short: Unbillable Time in Collaborative Care for Co-occurring Opioid Use and Mental Health Conditions
T2 - Psychiatr Serv
TI - When Billing Codes Fall Short: Unbillable Time in Collaborative Care for Co-occurring Opioid Use and Mental Health Conditions
U1 - Financing & Sustainability; Opioids & Substance Use
U3 - 10.1176/appi.ps.20250715
VL - 77
VO - 1075-2730
Y1 - 2026
ER -