Collaborative Care Model Billing: 99492, 99493, 99494 Explained

Updated October 2026. Written by Matteo Grassi, cofounder of HANA Health, trained in psychology.

Collaborative Care Model (CoCM) billing is how Medicare pays a practice for a behavioral health care manager's monthly work, backed by a psychiatric consultant. CPT 99492 covers the first 70 minutes in the first month, 99493 covers 60 minutes in each later month, and 99494 adds each extra 30 minutes. In 2026 the national non facility rates are $160.32, $144.96 and $61.46.

I've worked both sides of the patient call, and CoCM is the care management model where the clinical logic and the billing logic line up best.

Key facts

• Team: CoCM needs three roles, a treating (billing) practitioner, a behavioral health care manager and a psychiatric consultant, per the CMS Behavioral Health Integration booklet (2026).
• Time: 99492 is 70 minutes in the first month and 99493 is 60 minutes in later months, counted from the care manager only, per the University of Washington AIMS Center quick guide (2026).
• 2026 national payment: $160.32 for 99492, $144.96 for 99493 and $61.46 for each unit of 99494 in a non facility setting, before geographic adjustment, per the same AIMS Center guide.
• Add on limit: Medicare allows up to 4 units of 99494 per patient per month, per the AIMS Center guide (2026).
• Growth: Medicare CoCM services rose from 55,082 to 284,062 between 2018 and 2024, and general BHI (99484) services rose from 24,033 to 473,156, per Blunt et al., JAMA Network Open (2026).
• New for 2026: CMS finalized add on codes G0568, G0569 and G0570 so APCM practices can bill CoCM or general BHI services, per the CMS CY 2026 Physician Fee Schedule final rule fact sheet (2025).

What is the Collaborative Care Model and who has to be on the team?

The Collaborative Care Model is a form of behavioral health integration where a primary care or specialty team adds a care manager and a psychiatric consultant to usual care. CMS describes two added services: care management support for patients in behavioral health treatment, and regular psychiatric consultation between specialties.

The team has three members.

• Treating (billing) practitioner: a physician, nurse practitioner or physician assistant. This person bills the codes and directs the care.
• Behavioral health care manager: someone with formal education or specialized training in behavioral health, such as social work, nursing or psychology, working under the billing practitioner's oversight.
• Psychiatric consultant: a medical provider trained in psychiatry who can prescribe the full range of medications. The consultant can be, and usually is, remote, and isn't generally expected to treat the patient directly.

The patient counts as an active member of the team too. Care runs in episodes. An episode ends when treatment goals are met, when the team refers the patient to direct psychiatric care, or after 6 consecutive months with no CoCM.

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

The descriptors say 70, 60 and 30 minutes, but CMS states that CPT time rules apply. Under those rules a code is reportable once you pass the midpoint of its time. Here is the code by code list.

• 99492: first month of an episode. Descriptor time is 70 minutes. Reportable from 36 minutes.
• 99493: each later month. Descriptor time is 60 minutes. Reportable from 31 minutes.
• 99494: add on for each additional 30 minutes in any month. Reportable once 16 minutes pass the full time of the base code. Medicare allows up to 4 units a month.
• G2214: the first 30 minutes in any month, for a month where you don't reach the base code. Reportable from 16 minutes.

Only the care manager's minutes count toward these thresholds. The psychiatric consultant's time and the billing practitioner's time are already built into the code values. CMS assumes about 30 minutes of billing practitioner time for 99492, 26 for 99493 and 13 for each 99494 unit.

Psychotherapy time doesn't count either. A licensed clinician can bill therapy in the same month, but those minutes can't also go toward the CoCM threshold.

What does Medicare pay for CoCM codes in 2026?

Medicare pays $160.32 for 99492 and $144.96 for 99493 as national non facility rates in 2026, and $61.46 for each 99494 unit. General BHI code 99484 pays $57.45 for comparison. Your locality changes these numbers a little, and the patient owes 20% Part B coinsurance.

Here's a worked example for one patient over six months, using the national rates.

• Month 1: 99492 at $160.32.
• Months 2 to 6: 5 months of 99493 at $144.96 each, which is $724.80.
• Six month total: $160.32 plus $724.80 equals $885.12.
• A heavier month, 99493 plus one unit of 99494: $144.96 plus $61.46 equals $206.42.

Now scale it. A steady panel of 40 patients, each billing 99493, comes to $5,798.40 in a month. That's the revenue side only. It doesn't subtract the care manager's pay, the psychiatric consultant's fee, registry tools or the coinsurance you don't collect. Run your own numbers with your own labor costs before you commit.

What has to happen before you bill the first month?

You need an initiating visit, patient consent and a tracking system. The AIMS Center guide says an initiating visit is required before billing CoCM or general BHI codes for new patients, or for patients not seen in the year before services start. At that visit the treating practitioner assesses the patient and gets broad consent to consult with specialists.

Consent can be verbal, but it has to be documented in the medical record. It should also tell the patient that Part B cost sharing applies, because CMS says cost sharing and advance consent apply to each service independently.

The CMS booklet lists the clinical components that sit behind the codes.

1. Outreach to and engagement of the patient, directed by the billing practitioner.
2. An initial assessment using validated rating scales, with an individualized treatment plan.
3. Entry into a registry, with tracking of follow up and progress.
4. A weekly caseload review between the care manager and the psychiatric consultant.
5. Brief evidence based interventions, such as behavioral activation or motivational interviewing.
6. Ongoing monitoring with validated rating scales and relapse prevention planning.

If the registry or the weekly review isn't happening, the code isn't supported, however many minutes you logged.

Can you bill CoCM in the same month as CCM, APCM or general BHI?

Sometimes, but the rules differ for each pairing. CMS says CCM and BHI are distinct services and can be billed for the same patient in the same month if advance consent covers both, all requirements for each are met, and no time is counted twice. Only one practitioner can report CCM in a month.

General BHI code 99484 and CoCM describe different models, so don't report both for the same time. If a patient doesn't reach the CoCM threshold, 99484 or G2214 may fit better. The CMS code selection guidance is to use the code that most specifically describes the service.

APCM is different. For 2026 CMS finalized G0568 and G0569 as add ons that are comparable to 99492 and 99493, and G0570 as the add on comparable to general BHI. They're billed with an APCM base code by the same practitioner in the same month. If you're weighing APCM against CCM first, our post on why APCM and CCM can't be billed together covers that decision.

Why is CoCM billing still uncommon?

CoCM billing has grown fast but from a small base. Between 2018 and 2024, Medicare allowed 829,044 CoCM services and 1,356,006 general BHI services, and annual CoCM volume rose from 55,082 to 284,062, according to Blunt et al. in JAMA Network Open.

The authors note limits. Their data came from Medicare fee for service summary files, suppressed small cells so totals are lower bounds, and couldn't tell whether growth came from more practices or heavier use by existing ones. Their paper focused on oncologists, who billed under 1% of services, and they suggested the infrastructure and administrative load may hold practices back.

The operational pieces are where the effort goes: running a registry, protecting a weekly consultant slot and keeping the care manager in contact with patients between visits. The billing codes are the easy part to learn. The workflow behind them is what the codes pay for.

What this means for your practice

Start with the workflow, then the codes. Decide who your care manager and psychiatric consultant will be, how you'll track patients in a registry, and when the weekly review happens. Then pick a small first panel and bill only what your documentation supports.

A few practical steps help.

1. Confirm each patient had an initiating visit and documented consent that mentions cost sharing.
2. Log care manager minutes by patient and by month, and keep psychotherapy minutes separate.
3. Check your Medicare Administrative Contractor and your commercial payers for coverage before month one.
4. Compare the other monthly services your practice may already bill, starting with our CCM billing codes guide.

At HANA Health we help practices run the outreach and follow up between visits so care teams spend their time on patients rather than phone tag. You can see how that works on the HANA Health practice page, and the CCM guide shows how it compares with chronic care management.

Frequently asked questions

How many minutes do I need to bill 99492?

CMS says CPT time rules apply to CoCM, so 99492 becomes reportable once the care manager passes the midpoint of 70 minutes, which is 36 minutes. Check your payer's rules, because some commercial plans require the full time.

Does the psychiatric consultant have to see the patient?

No. CMS describes the consultant as someone who is generally not expected to have direct patient contact or prescribe. The consultant reviews caseloads, advises the team and recommends referral for direct psychiatric care when needed.

Can a nurse or social worker be the care manager?

Yes, if they have formal education or specialized training in behavioral health and work under the billing practitioner's oversight. Social work, nursing and psychology are the examples CMS gives. Payer qualifications can vary.

What happens if I don't reach the CoCM time threshold?

You can't bill the base code. Depending on the minutes and the model you used, G2214 or general BHI code 99484 may apply. Don't count time twice across services.

Can FQHCs and rural health clinics bill CoCM?

Yes. CMS retired the bundled code G0512 on 1 January 2026, so these clinics now bill 99492, 99493, 99494 and G2214 under the standard rules, according to the AHRQ Integration Academy.

Sources

1. Centers for Medicare & Medicaid Services, MLN909432 Behavioral Health Integration Services, 2026.
2. Centers for Medicare & Medicaid Services, Frequently Asked Questions about Billing Medicare for Behavioral Health Integration Services.
3. Centers for Medicare & Medicaid Services, CY 2026 Medicare Physician Fee Schedule Final Rule fact sheet, 2025.
4. Blunt K, Johns K, McAlearney AS, Miller LE. Trends in Medicare Billing by Oncologists for Integrated Mental Health Care Services. JAMA Network Open, 2026.
5. University of Washington AIMS Center, Quick Guide on Behavioral Health Integration Services, updated February 2026.
6. AHRQ Integration Academy, New Medicare Billing Practices for Collaborative Care Take Effect, 2026.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you want to talk through how a CoCM or care management program would run in your practice, book a discovery call.