A new CoCM Financial Analysis Template, CoCM Template User Guide and CoCM Billing Code Summary give California Federally Qualified Health Centers (FQHCs) a roadmap to make the Collaborative Care Model (CoCM) work—clinically and financially.
Perinatal mood and anxiety disorders (PMADs) affect roughly 1 in 5 pregnant patients in California, and maternal suicide remains a leading cause of preventable mortality in the state. Despite the scale of the problem, 75% of mothers who need mental health treatment never receive it. There are many reasons for this gap in care. One major challenge is establishing evidence-based programs that follow patients over time to ensure they continue to get the care they need to improve. Another is finding ways to implement and deliver these programs in a manner that is financially sustainable. Over the last five years, the Los Angeles Maternal Mental Health Access (LAMMHA) program has worked to support Los Angeles County health centers to implement the Collaborative Care Model (CoCM), a model of care aimed at addressing both key challenges.
Collaborative Care Is a Proven Model That Helps Patients Get Better
CoCM is a highly evidence-based model of care with over 90 randomized controlled trials showing it is more effective than standard care in improving maternal mental health conditions. CoCM is a team-based integrated behavioral health model developed at the University of Washington. It pairs a Behavioral Health Care Manager (BHCM)—typically a licensed clinical social worker—with a psychiatric consultant and a primary care provider to treat common conditions like depression and anxiety in the primary care setting. The model of care has been shown in a variety of primary care settings to improve both access and clinical outcomes, and to increase patient satisfaction. LAMMHA health centers have been implementing CoCM specifically for patients experiencing perinatal mood and anxiety disorders. Now, two new resources developed through the LAMMHA program are helping clinics answer a critical question: Is it financially sustainable to do this work?
The Clinical Model Can Also Be Financially Sustainable
To help FQHCs evaluate whether CoCM can pay for itself, LAMMHA partnered with Curt Degenfelder Consulting, Inc. to develop the CoCM Financial Analysis Template and related CoCM Template User Guide. Rather than starting from scratch, the template was built using actual data from participating LAMMHA health centers—capturing staffing costs, productivity rates, payor mix, case management volumes, and overhead structures that reflect the real operating conditions of Los Angeles County community clinics.
A sample calculation shows a half-time licensed clinical social worker (LCSW) generating approximately $124,900 in annual revenue against $120,000 in costs—a program that essentially breaks even, allowing clinics to add CoCM without negative financial impact to their overall operations. For more information on CoCM and using the developed tools, please see the LAMMHA Financial Analysis Webinar recording.
The Financial Analysis Template walks through four accounting categories:
- Revenue: driven by BHCM FTEs, annual visit productivity, and Medi-Cal payor mix (typically 99% for this population)
- Case Management: projecting revenue from monthly care management visits for higher-acuity patients, billable via code G0323
- Expenses: BHCM salary and fringe costs plus the contracted psychiatric consultant, whose time is unbillable but essential
- Support and Overhead: four methodology options, from incremental-only to full site cost allocation
Cracking the Medi-Cal Billing Puzzle
A companion CoCM Billing Code Summary addresses another challenge many clinics face: getting paid for the work they are doing. In LAMMHA, sites were doing all the work of CoCM but not billing the available CoCM codes to Medi-Cal. This was in part because of the complexity of FQHC billing rules.
The core issue is that Medi-Cal’s Prospective Payment System (PPS) requires a documented qualifying patient visit—face-to-face or via telehealth—before a billing code generates a reimbursable encounter. Because the CoCM codes were designed for fee-for-service settings, applying them at FQHCs requires additional workflow steps.
The developed CoCM Billing Code Summary includes month-by-month billing scenarios walking through a sample patient—a pregnant woman with moderate depression—from initial enrollment through postpartum stabilization, illustrating exactly which codes apply at each stage and how many PPS visits are achievable per month (typically 2-3).
The developed CoCM billing summary identifies three viable code pathways:
- 99492/99493/99494 (CoCM-specific codes) — Accurate and clinically descriptive, but require the primary care provider to bill on behalf of the BHCM and careful scheduling to avoid same-day conflicts with other qualified visits
- G0323 (General BH Care Management) — A simpler option billable by the BHCM directly for a 15-minute qualifying visit; confirmed by DHCS as PPS-eligible
- Z6304/Z6308 (CPSP Psychosocial Codes) — A strong option for FQHCs participating in the Comprehensive Perinatal Services Program with high CPSP enrollment
Effective Care and a Clear Financial Path Forward
Together, these tools give California FQHCs something they’ve been missing: a practical, data-backed roadmap for implementing the highly effective Collaborative Care Model in a financially sustainable way.
The billing guidance also highlights an important policy issue. Right now, FQHCs receive the same PPS payment regardless of which billing code is used. That means CoCM services don’t stand out in claims data, making it difficult for DHCS and Medi-Cal managed care plans to see where collaborative care is being delivered. As shown in the companion CoCM Billing Code Summary, California may want to consider an approach similar to North Carolina’s March 2025 guidance, which carved CoCM out of the PPS rate calculation entirely and created a separate, dedicated billing code (G0512) so that collaborative care activity is properly tracked and reimbursed.
For Los Angeles County health centers ready to move forward, these resources are available through the LAMMHA program page and are highlighted in the LAMMHA Financial Analysis Webinar recording. For more information on perinatal mental health resources in California, visit the California Department of Public Health’s Maternal Mental Health page.
The Los Angeles Maternal Mental Health Access (LAMMHA) program is a five-year initiative funded by the California Health Care Foundation (CHCF) and led by the Community Clinic Association of Los Angeles County (CCALAC) in collaboration with Maternal Mental Health Now, Elevation Health Partners, Concert Health, UCLA, and the University of Washington AIMS Center. The program supports Los Angeles County health centers to implement the Collaborative Care Model (CoCM). For more information and previous blog posts, visit the CCALAC LAMMHA program page.
Co-authors:
Sarah Arnquist, MPH
SJA Health Solutions
Curt Degenfelder, President
Curt Degenfelder Consulting, Inc.