Collaborative Care Billing (CoCM): 99492, 99493, 99494 and G2214 Explained

The Collaborative Care Model (CoCM) is billed by the treating practitioner, usually primary care, with CPT 99492 for the first month, 99493 for each later month and 99494 for extra time, plus Medicare’s G2214 for months with less care manager time. The work is done by a team: the treating practitioner, a behavioral health care manager and a psychiatric consultant. Psychiatrists and PMHNPs who act as the consultant are usually paid by the primary care practice under a contract, not by billing insurance directly.

Collaborative Care lets primary care treat common mental health conditions such as depression and anxiety with regular input from psychiatry. For psychiatry practices and PMHNPs, it is a way to support many more patients than visits alone allow, but only if the team, the time tracking and the billing are set up correctly.

Who does what

Role	What they do	Bills the CoCM codes?
Treating practitioner (MD, DO, NP or PA, usually in primary care)	Directs care, diagnoses, prescribes, and stays responsible for the patient	Yes
Behavioral health care manager (often a nurse, social worker or counselor)	Initial assessment, follow-up contacts, brief interventions, tracks symptoms in a registry, coordinates with the consultant	No; their time is what the codes count
Psychiatric consultant (psychiatrist, or a PMHNP where allowed)	Reviews the caseload, usually weekly, and recommends treatment changes	No; paid by the billing practice under an agreement

The psychiatric consultant usually does not see the patient. If they do see the patient for a separate visit, that visit is billed separately with the usual codes, such as an E/M visit or a psychiatric evaluation.

The codes

Code	What it covers	Time in the code description
99492	First calendar month of Collaborative Care	70 minutes of care manager time
99493	Each later calendar month	60 minutes
99494	Add-on to 99492 or 99493 for each additional 30 minutes	30 minutes
G2214 (Medicare)	First 30 minutes of care manager time in a month that does not reach the time for 99492 or 99493; not billed with the other Collaborative Care codes	30 minutes
99484	General behavioral health integration, for practices not using the full CoCM model	20 minutes

Time rules matter. Count only care manager time spent on Collaborative Care activities in that calendar month, and keep a log of each contact. CPT and Medicare set the minimum time needed before each code can be reported; follow the current CPT time rules and each payer’s policy rather than rounding up. Months where the minimum is not reached are not billable under these codes.

What must be in place before you bill

1. An initiating visit. For Medicare, the treating practitioner must have seen the patient, for example in an E/M visit or annual wellness visit, before Collaborative Care starts, if the patient is new or has not been seen recently.
2. Patient consent. The patient agrees to Collaborative Care, including consultation with a psychiatric specialist, and is told that cost sharing applies. Document it.
3. A registry. Track every enrolled patient, with regular symptom scores such as the PHQ-9 for depression or the GAD-7 for anxiety.
4. A psychiatric consultant agreement. A written contract that sets out caseload reviews, how recommendations are shared, and how the consultant is paid.
5. A time log. Care manager minutes per patient per month, with what was done.

How psychiatrists and PMHNPs get paid

The consultant’s payment comes from the primary care practice, so the contract is where the money is decided. Common models:

• A monthly fee for a set number of weekly caseload reviews.
• An hourly rate for review time.
• A share of the practice’s Collaborative Care collections.

Whatever the model, agree on it in writing, and make sure it does not depend on referrals for other services. If the consultant also sees some patients directly, those visits are billed separately; see our guides to billing 99214 with 90833 and telehealth billing.

Common Collaborative Care billing errors

Error	Result	Fix
Billing 99492 a second time for the same episode	Denial or later recoupment	Use 99492 only for the first month of an episode; later months are 99493
No documented consent	Claim can be taken back on audit	Record consent before the first billed month
Counting consultant or treating practitioner time as care manager time	Overbilling risk	Log care manager time separately
Billing a month that did not reach the minimum time	Denial or recoupment	Check the time log before submitting
Psychiatric consultant billing the CoCM codes	Denial	Only the treating practitioner bills; the consultant is paid under contract

Coverage beyond Medicare

Medicare covers Collaborative Care under the codes above. Many commercial plans and some Medicaid programs also cover it, but the details vary: some use the same CPT codes, some need prior authorization, and some do not cover it at all. Check each payer before you enroll patients. Federally qualified health centers and rural health clinics have their own billing rules.

This guide is general information, not legal advice. CMS and payer rules change, so confirm current requirements on the CMS website and with each payer before billing.

How RevenueCTRL can help

We bill for psychiatry and PMHNP practices, including visits alongside Collaborative Care arrangements, and we credential PMHNPs with the payers they need (PMHNP credentialing). If you are adding Collaborative Care or another new service, a free 90-day claims audit shows where your current claims are losing money before you grow.

Frequently asked questions