CPT 99492 Quick-Read Guide for Mental Health Providers

What is CPT 99492 and When is It Used?

Definition: CPT 99492 is the code for Initial psychiatric collaborative care management, covering the first 70 minutes of care management services in the first calendar month of the Collaborative Care Model (CoCM). ¹ It represents a monthly bundle of services for managing a patient’s behavioral health condition in a primary care setting with a team-based approach. ²

Collaborative Care Model Context: This code is used when a primary care or treating provider works with a behavioral health care manager (often a therapist or social worker) and a psychiatric consultant (usually a psychiatrist) to provide coordinated mental health care. ⁴ It’s part of Medicare’s Behavioral Health Integration (BHI) services designed to integrate mental health services into primary care for better outcomes. ⁵

When to Use: Use CPT 99492 for the initial month of CoCM services after enrolling a patient into a collaborative care program. It applies once the care team has engaged the patient and provided the required elements (assessment, care plan, etc.) for about 70 minutes in that first month. ³

Can Mental Health Professionals Bill 99492?

Billing Provider Requirements: CPT 99492 is typically billed by a physician or qualified medical provider (e.g., primary care physician, internist, pediatrician, NP, PA) who manages the patient’s overall care. ⁵

Role of Therapists & Psychiatrists: Mental health professionals do not bill 99492 independently under Medicare. The CoCM requires a team of three:

• Treating (Billing) Practitioner
• Behavioral Health Care Manager (BHCM)
• Psychiatric Consultant

The BHCM and psychiatric consultant contribute to services billed under the treating provider’s NPI.

“Incident to” Billing: Services from the BHCM and psychiatric consultant are billed “incident to” the medical provider. ³ They can be staff or contracted providers. Medicare also introduced HCPCS code G0323 for BHI led by therapists ⁴, but 99492 still requires medical oversight.

Patient Eligibility and Consent

Eligibility: Any patient with a behavioral health or substance use disorder appropriate for collaborative care. Depression, anxiety, PTSD, and similar conditions qualify. ³

Consent: Patient consent must be documented. It can be verbal but must include:

• Description of CoCM
• Understanding of co-pays
• Agreement to participate ³

Initiating Visit: Must be a face-to-face visit with the billing provider if patient is new or hasn’t been seen in the past year. ⁶

What Services Count Toward 99492’s Billable Time?

Covered Activities:

• Outreach & engagement
• Initial assessment using rating scales (e.g., PHQ-9, GAD-7)
• Care plan development
• Registry tracking and updates
• Psychiatric consultant case review
• Brief therapeutic interventions
• Care coordination ³

Excluded Activities:

• Face-to-face visits by the PCP
• Full psychotherapy sessions (billed separately)
• Administrative-only tasks

Time Requirements and Documentation

Threshold: 70 minutes of BHCM and consultant time in a month. Minimum of >35 minutes to bill 99492. Use G2214 if 30+ but <70 minutes. ³

Documentation Should Include:

• Dated time logs
• Assessment and score summaries
• Treatment plan and goals
• Consultant notes
• Use of registry
• Consent documentation ⁶

Billing and Reimbursement

Submission: CPT 99492 is billed once per month, typically on the last day of the month. Use 99493 in subsequent months and 99494 for additional 30-minute increments.

Reimbursement:

• Medicare average payment: ~$145 non-facility, ~$91 facility ⁶
• Patient responsibility: Part B co-insurance (approx. 20%)

Other Payers: Many commercial plans and Medicaid programs reimburse CoCM codes. FQHCs and RHCs use HCPCS G0512. ^{[5] (#sources)} Important: Do not bill 99492 in the same month as 99484 for the same patient.

Why Use CPT 99492?

• Improved Outcomes: Data shows CoCM improves depression/anxiety outcomes through measurement-based care. ³
• Expanded Access: Allows mental health care in primary care, reducing stigma and access barriers. ¹
• Support for Clinicians: BH professionals contribute without needing separate billing; psychiatrists extend reach via consultation.
• Payment for Coordination: Compensates time spent outside direct patient encounters.
• Satisfaction: Patients appreciate proactive support; providers value shared care and reduced burnout.

Bottom Line: CPT 99492 enables sustainable, team-based mental health care in primary care. Understanding its rules helps mental health professionals integrate into collaborative models, expand care, and secure reimbursement.

Sources:

1. AMA - Learn about 4 new CPT codes to bill for collaborative care and case management https://www.ama-assn.org/practice-management/cpt/learn-about-4-new-cpt-codes-bill-collaborative-care

2. AAPC - CPT® Code 99492 - Psychiatric Collaborative Care Management Services https://www.aapc.com/codes/cpt-codes/99492

3. CMS - MLN909432 Behavioral Health Integration Services https://www.cms.gov/files/document/mln909432-behavioral-health-integration-services.pdf

4. CMS - Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/behavioral-health-integration-faqs.pdf

5. Psychiatry.org - Get Paid for Integrated Care Services https://www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/get-paid

6. AIMS Center - University of Washington - Quick Guide: CMS BHI and CoCM (2024) https://aims.uw.edu/wordpress/wp-content/uploads/2023/06/Quick-Guide-CMS-BHI-CoCM-2024.pdf