Oncologists billed for fewer than 1% of Medicare claims for integrated mental health services from 2018 to 2024, even as overall use increased nationally, according to a cross-sectional analysis published in JAMA Network Open by Koral Blunt, MD, of The Ohio State University College of Medicine, Columbus, and colleagues.
Depression and anxiety are common in patients with cancer and can worsen symptoms, treatment adherence, quality of life, and survival. Guidelines recommend routine screening and team-based mental health care. However, the researchers noted that access to mental health services can be challenging during active cancer treatment due to competing appointments, and patients may not reliably receive support through primary care. Prior to this analysis, the extent to which oncologists billed for these services was uncertain.
“Several mechanisms likely contribute [to limited billing among oncologists]: the [collaborative care model] requires substantial infrastructure, which may be prohibitive for practices facing operational constraints; administrative complexity may limit implementation; alternative but less efficient referral pathways may predominate; and some health care systems may utilize grants or philanthropy to fund these services,” the researchers wrote.
Study Design
Researchers analyzed Medicare Physician/Supplier Procedure Summary files from 2018 through 2024 to examine billing trends for integrated mental health services. The analysis aggregated services by Healthcare Common Procedure Coding System codes and clinician specialty.
The collaborative care model (CoCM) integrates the treating clinician, a behavioral health manager, and a psychiatric consultant to manage depression and related conditions. Behavioral health integration provides a related but less intensive framework for incorporating behavioral health services into medical care. Both models have distinct Medicare reimbursement pathways.
‘Scant’ Billing by Oncologists
Across all specialties, clinicians billed 2.1 million integrated mental health services to Medicare beneficiaries between 2018 and 2024, including 829,044 CoCM services and 1.3 million behavioral health integration (BHI) services.
Utilization increased during the study period from 55,082 to 284,062 CoCM services and from 24,033 to 473,156 BHI services.
Mann-Kendall tests showed increasing trends in total CoCM services, total BHI services, and oncology CoCM services, whereas oncology BHI service counts and the oncology share of BHI services did not increase. Each year, oncology clinicians accounted for fewer than 1% of billed CoCM and BHI services.
Takeaway
The researchers noted several limitations. First, claims involving 1 to 10 services were suppressed in the data set, resulting in lower-bound national estimates. The analysis also could not link services to individual clinicians or beneficiaries, so increases could reflect broader adoption, more intensive use by existing users, or changes in patient mix. In addition, data from federally qualified health centers, Medicare Advantage plans, and commercial payers were not included. Finally, specialty coding may lead to misclassification if multidisciplinary practices submitted claims under nononcology designations.
“CoCM and BHI service utilization grew significantly from 2018 to 2024, but oncologist billing remained scant,” the researchers concluded. “Closing this gap is an opportunity to improve cancer care quality and patient wellbeing.”
Looking ahead, they stated, “CoCM and BHI services can be embedded in oncology practices to reach patients efficiently, support value-based oncology, and reduce disparities. Health systems should pilot oncology-specific models, such as centralized care managers and psychiatrists serving multiple clinics, integrating symptom tracking into routine workflows, and automating billing. Policy efforts could include risk-adjusted payment models and quality measures emphasizing sustained engagement.”
Disclosure: The researchers reported no conflicts of interest.
Source: JAMA Network Open