How do you bill the Collaborative Care Model codes 99492 to 99494?

What are CPT codes 99492, 99493 and 99494?

CPT 99492, 99493 and 99494 are the psychiatric collaborative care management codes, the billing side of the Collaborative Care Model (CoCM). They pay the treating practice for a behavioral health care manager’s time on one patient across a calendar month, working with a psychiatric consultant who reviews the caseload every week. 99492 covers the first 70 minutes in the first month of care, 99493 covers the first 60 minutes in each later month, and 99494 adds each further 30 minutes in any month. HCPCS code G2214 covers 30 minutes in a month that starts but cannot reach the base code.

Who does what in psychiatric collaborative care management?

• Treating practitioner. The physician or non-physician practitioner who directs care and submits the claim, usually a primary care doctor, NP or PA. CMS values 30, 26 and 13 minutes of this practitioner’s work into 99492, 99493 and 99494.
• Behavioral health care manager. Clinical staff with formal education or specialized training in behavioral health, such as social work, nursing or psychology. They work under general supervision, so the practitioner does not need to be on site, and they can work remotely.
• Psychiatric consultant. A clinician trained in psychiatry and qualified to prescribe the full range of medications. They review the caseload with the care manager each week and generally have no direct contact with the patient.

The consultant and the care manager never bill these codes. The treating practitioner bills and pays them through employment or a contract. That team structure is what separates CoCM from general behavioral health integration, 99484, which needs 20 minutes of clinical staff time and no psychiatric consultant. For how collaborative care sits inside a psychiatric practice’s wider code set, see our psychiatry billing guide.

How do you bill CoCM codes step by step?

You bill CoCM once per patient per calendar month, after the month closes, from the minutes the care manager logged. This is the sequence a clean first claim needs.

1. Confirm an initiating visit. New patients, and anyone the billing practitioner has not seen in the past year, need a qualifying visit before CoCM starts: an E/M visit other than 99211, an annual wellness visit, an initial preventive physical exam or transitional care management.
2. Get and document consent. Verbal consent is enough, but it goes in the record, and the patient must be told that cost sharing applies. A new consent is needed only if the patient moves to a different billing practitioner.
3. Enter the patient in a registry. Score them with a validated scale such as the PHQ-9 or GAD-7 at the start, then repeat it to track progress against a treatment target.
4. Log every care manager minute. Record date, activity and minutes: outreach, assessment, follow-up calls, care planning, and time spent preparing for and attending the weekly caseload review.
5. Total the month and pick the code. Use the time table below. 99492 is used only in the first month of an episode.
6. Check the month for conflicts. No 99484 for the same patient, and no minute counted toward both CoCM and another care management service.
7. Submit under the treating practitioner. Use that practitioner’s NPI and the place of service where they normally see patients face to face.

Each step maps to a denial we see often. Checking care management time against the right code is part of our medical coding service. Eligibility and coverage errors caused 24% of denials in our claim audit, so we verify each patient’s plan before month one through eligibility and prior authorization work.

When does a CoCM episode start and end?

An episode starts with the first month of care manager time. It ends when the patient meets the treatment goals, is referred on for direct psychiatric care, or goes 6 consecutive months with no CoCM services. A patient who returns after that break starts a new episode, and the first month bills as 99492 again. AIMS Center guidance puts a typical episode at roughly 6 to 12 months.

How many minutes do you need to bill 99492, 99493 and 99494?

You need 36 care manager minutes to bill 99492, 31 minutes to bill 99493 and 16 extra minutes for each unit of 99494. CMS states that CPT time rules apply to CoCM, which means a code is billable once more than half its time is met. The 70 and 60 in the descriptors are the full time values, not minimums.

Past the base code’s full time, each 99494 unit starts 16 minutes into a new 30-minute block: 86 minutes in month one, 76 in a later month.

Reading 70 and 60 as floors is the most expensive mistake on this page. In our billing reviews, 31% of patient-months with 36 to 69 minutes logged were never billed, because the team waited for the full 70.

When do you use G2214 instead of 99492 or 99493?

Use G2214 for a month that starts but falls short of the base code, usually because the patient was hospitalized, referred for specialized care or stopped engaging. It needs 16 minutes, can be billed in a first or later month, and pays $60.79 nationally in 2026. G2214 was never billed in 47% of CoCM practices we reviewed, which leaves every short month in the caseload unpaid.

How many units of CPT 99494 can you bill?

Medicare pays a maximum of four units of 99494 per patient per month, a medically unlikely edit in place since July 1, 2024. Each unit needs 16 minutes beyond the base code’s full 70 or 60. 99494 is an add-on, so it always goes on the same claim as 99492 or 99493 and is never billed alone.

How much does Medicare pay for collaborative care codes in 2026?

In 2026 the national Medicare non-facility rate is $160.32 for 99492, $144.96 for 99493, $61.46 for each unit of 99494 and $60.79 for G2214, against $57.45 for general BHI code 99484. Facility rates are lower: $82.17, $89.51, $36.07 and $33.73.

The chart shows 99492 at $160.32 and 99493 at $144.96, each more than twice the $61.46 add-on and the $60.79 G2214 rate.

These are allowed amounts at the 2026 conversion factor of $33.40, or $33.57 for qualifying APM participants, adjusted for your locality. Medicare pays 80% and the patient owes the 20% Part B coinsurance once the $283 annual deductible is met, which is why consent has to mention cost sharing. Patients in the Qualified Medicare Beneficiary program cannot be billed that share. Medicaid covers CoCM in more than half of states, and commercial rates depend on each contract, so check every plan before the first month.

What does a CoCM caseload bill in a month? A worked example

A 3-provider primary care practice with 60 active CoCM patients bills $8,815.81 in Medicare allowed amounts for one month when it applies CPT time rules, against $4,618.66 when it bills only patients who reach the full 70 or 60 minutes.

The practice has one full-time care manager. This month 15 patients are in their first month of care and 45 are in a later month. The minute log shows:

• First month: 10 patients at 36 to 85 minutes, 3 patients at 86 to 115 minutes and 2 patients at 16 to 35 minutes.
• Later months: 30 patients at 31 to 75 minutes, 8 patients at 76 to 105 minutes and 7 patients at 16 to 30 minutes.

Billed with CPT time rules: 13 units of 99492 at $160.32 ($2,084.16), 38 units of 99493 at $144.96 ($5,508.48), 11 units of 99494 at $61.46 ($676.06) and 9 units of G2214 at $60.79 ($547.11). Total: $8,815.81.

Billed on full minutes only: the team bills 99492 for the 7 first-month patients who reached 70 minutes ($1,122.24), 99493 for the 22 later-month patients who reached 60 ($3,189.12), 99494 only for the 5 patients with a full extra 30 minutes ($307.30), and no G2214. Total: $4,618.66.

The chart shows the gap code by code: 99493 falls from $5,508.48 to $3,189.12, 99492 from $2,084.16 to $1,122.24, and G2214 from $547.11 to zero. That is $4,197.15 a month, or $50,365.80 a year, from minutes the care manager already worked. For how care management revenue fits alongside visits and preventive care, see our primary care revenue cycle guide.

Which codes can you bill in the same month as CoCM?

You can bill CoCM in the same month as chronic care management, psychotherapy and office visits, since only the initiating visit is required, but not with general BHI code 99484 for the same patient.

• 99484 general BHI: not allowed in the same month as 99492, 99493, 99494 or G2214 for the same patient.
• Chronic and principal care management: allowed in the same month when the patient consents to both and each minute counts toward one service only. Chronic care management time went uncaptured for 58% of eligible patients in our billing reviews, so practices running both programs often leave money in each.
• Psychotherapy: a licensed care manager can bill psychotherapy codes in the same month, but psychotherapy minutes do not count toward CoCM time.
• APCM behavioral health add-ons: practices billing advanced primary care management can report G0568 for an initial CoCM month, G0569 for later months or G0570 for general BHI, when the APCM base code is billed by the same practitioner in the same month. These add-ons are not time based and pay $161.66, $145.96 and $57.78 nationally in 2026.

How do FQHCs and RHCs bill CoCM in 2026?

From January 1, 2026, CMS retired G0512 and G0511 for health centers. FQHCs and RHCs now report the individual codes that G0512 used to bundle, 99492, 99493, 99494 and G2214, instead of one 60-minute code, and CMS pays them at the national non-facility rate. The same time rules and the four-unit limit on 99494 apply.

What CoCM billing mistakes cause denials?

Most CoCM denials start with how the episode was set up, not with the minutes. Missing consent documentation caused 34% of CoCM denials in our claim audit.

The rest of the denials split three ways: 27% lacked a qualifying initiating visit, 22% used the wrong month’s code and 17% were billed alongside 99484 in the same month.

• Billing the wrong month’s code. 99493 was billed in the first month on 9% of new episodes, and payers deny it when no 99492 exists for the episode.
• Restarting 99492 too soon. A new episode needs a 6-month break with no CoCM. A patient who returns after 3 months stays on 99493.
• Counting minutes twice. The same phone call cannot count toward CoCM and chronic care management.
• Billing under the consultant. Claims under the psychiatrist’s NPI, when the psychiatrist acts as consultant, are wrong from the start.
• Thin documentation of the caseload review. Note the date of each weekly review and the treatment changes it produced, because it is the element that proves the CoCM model is in place.

Denials are usually recoverable when worked quickly, yet 19% of denied claims were never reworked or appealed in the practices we reviewed. Appeals filed by Luxen were overturned 68% of the time. Working that queue is the core of our denials and AR recovery service.

Should collaborative care model billing stay in-house or be outsourced?

Keep CoCM billing in-house if the care manager’s minute log feeds the claim without re-keying and someone checks each month’s codes before submission. Outsource if claims wait on manual time counts or CoCM denials sit unworked. Fully loaded in-house billing cost 7.9% of collections for practices under $2M in our billing reviews, while outsourced billing typically runs 3% to 6% of collections.

Whichever route you take, ask these questions of the person or vendor doing the work:

• Can they read minutes straight from your registry or EHR, or does someone re-type them?
• Do they bill G2214 and 99494, or only the base codes?
• Do they track the 6-month break that resets an episode?
• Can they report CoCM denials separately from the rest of your claims?

If you are comparing vendors, our guide to medical billing companies covers pricing and contract terms, and our full-service medical billing team works inside your existing EHR with no migration. To see what your CoCM minutes should be billing, book a free billing review.

How do 99492, 99493, 99494, G2214 and 99484 compare?

The five codes split by month of care and time: 99492 opens an episode, 99493 covers each later month, 99494 adds time, G2214 covers short months, and 99484 is the separate general BHI code for practices without a psychiatric consultant.

Primary care and internal medicine

Most CoCM is billed by primary care, where the annual wellness visit doubles as the initiating visit and a PHQ-9 at that visit feeds the registry. The PCP is the treating practitioner, and the care manager is often an in-house LCSW or nurse. Because primary care also runs chronic care management, the rule that each minute counts once matters most here. Chronic care management time went uncaptured for 58% of eligible patients in our reviews, and CoCM minutes slip the same way. Our primary care billing page covers CCM, APCM and CoCM together.

Psychiatry and behavioral health

In the standard model the psychiatrist is the consultant, not the biller, so psychiatric practices usually earn from CoCM through contracts with primary care groups. Clinical psychologists and clinical social workers cannot bill 99492 to 99494 as treating practitioners. For care management of their own patients they bill G0323, which needs at least 20 minutes of their time in a calendar month. Claims sent to the medical plan instead of the behavioral health carve-out caused 12% of behavioral health denials in our claim audit, so confirm which benefit pays. See our therapist billing page for psychotherapy codes.

OB/GYN

Perinatal depression programs run CoCM out of obstetric practices, with the OB, NP or certified nurse-midwife as treating practitioner. The PHQ-9 or Edinburgh scale at a prenatal visit can start the registry. Many pregnant patients are on Medicaid, and Medicaid covers CoCM in more than half of states, so check the state manual and each managed care plan before the first month. Keep CoCM minutes separate from time documented for the maternity visits themselves.

Pediatrics

Pediatric CoCM usually targets adolescent depression and anxiety, screened with the PHQ-A or GAD-7 at well visits. Medicaid is the main payer, and state rules differ on which codes, modifiers and care manager credentials they accept. Consent involves the parent or guardian, and the record should show who gave it. Where Medicaid does not cover CoCM, some commercial plans do, so run coverage checks by plan rather than assuming one answer.

FQHCs and rural health clinics

2026 is the first year health centers bill CoCM line by line. G0512 ended on January 1, 2026, and FQHCs and RHCs now report 99492, 99493, 99494 and G2214 with the same time rules as other practices. That means billing teams must track minutes by month and episode instead of one 60-minute threshold. Visits billed under the wrong rendering provider caused 8% of RHC and FQHC denials in our claim audit. More on health center billing is on our FQHC billing page.

Dental, physical therapy and ambulance

Dental practices, physical therapy clinics and ambulance agencies cannot bill 99492 to 99494. CoCM needs a treating physician or NPP directing behavioral health care, a care manager and a psychiatric consultant, which these settings do not run. Their role is referral: a dentist or physical therapist whose patient screens positive for depression sends that patient to primary care, where the CoCM episode can start.