What is CPT 99493? CPT 99493 is one of the Psychiatric Collaborative Care Management (CoCM) codes. It covers the first 60 minutes in any subsequent calendar month of care management for a patient in a collaborative care program. 1 In practice, a CoCM team (PCP, behavioral health care manager, and psychiatric consultant) provides structured follow-up for patients with depression, anxiety, or other behavioral conditions. In the first month of care you would use 99492 (the initial 70-minute code) 2, and in later months use 99493 once at least 31 minutes of care manager time have accrued (per CPT’s midpoint rule). If the care manager spends more than 60 minutes in a month, additional 30-minute increments are billed with 99494 (an add-on code used alongside 99492/99493). (For example, 61–90 min in a month = 99493; 91–120 min = 99493+99494; etc.) 1
The CoCM model is team-based 3, and 99493 is designed for this setting. Required service elements include outreach and engagement, use of a patient registry, weekly case reviews with the psychiatrist, care-plan updates (with medication or therapy adjustments based on consultant input), and monitoring of patient status with validated scales. 1 Note that the patient must have had an “initiating” face-to-face visit (for example, a comprehensive E/M, Medicare Annual Wellness Visit, IPPE or TCM) before starting CoCM. 5 These codes are billed monthly for an episode of care until treatment goals are met or the patient leaves the program (an episode can span many months, pausing only if there is a 6-month gap in services). 3
The billing provider (“treating practitioner”) for 99493 must be a physician or other qualified provider with independent E/M privileges (e.g. MD, DO, NP, PA, CNS or CNM). 4 In most practices this is a primary care provider, but any specialist with E/M scope may bill if overseeing CoCM. The behavioral health care manager (typically a licensed social worker, nurse, or psychologist) performs the bulk of the time-based work under the provider’s direction. 3 The psychiatric consultant (a psychiatrist or qualified addiction psychiatrist) advises the team on diagnosis and medication; note that a psychiatrist generally should not bill the CoCM codes, since psychiatric input is built into 99492–99494. (If a psychiatrist is the only provider involved, use the General BHI code 99484 instead.)
Medicare allows 99493 in all outpatient settings. Report the place-of-service where the billing provider would normally see the patient (for example POS 11 for office). The code is priced both in facility and non-facility environments, so it can be billed even if the patient spends part of the month in a hospital or SNF. 3 CMS also covers CoCM in Federally Qualified Health Centers and Rural Health Clinics, but with special HCPCS codes (G0511/G0512) instead of 99492/99493. 1 Most state Medicaid programs and many commercial insurers have begun covering the CoCM codes as well 2, though policies vary. Always check payer policy: some plans require telehealth modifiers or specific place-of-service codes when these services are delivered remotely (see below).
CPT 99493 is strictly time-based. You may report it once a full calendar month has elapsed and the care manager has spent 60 minutes (or more) on CoCM activities. 3 By CPT “time rule,” you can bill 99493 as soon as 31 minutes of work are done (half of 60). If less than 31 minutes of care-management time are provided, do not report 99493 that month. When the care manager spends 61–90 minutes, 99493 is billed once. For each additional 30-minute block beyond 60 (e.g. 76–105 min, 106–135 min), append one unit of 99494 (in addition to 99493). All minutes counted toward these codes must be purely CoCM clinical work (face-to-face or non-face-to-face with the patient). 1
Documentation must capture the service elements required by CoCM. Note in the chart the patient’s treatment plan, the use of any validated rating scales, and updates via the registry. Record the care manager’s contacts (calls, messages, visits) and the weekly case-review meetings with the psychiatrist. Include details of any new recommendations (e.g. medication changes or brief psychosocial interventions) arising from the consultation. 1 As with any code, ensure that the medical record supports the time billed.
Medicare requires advance beneficiary consent before starting CoCM services. In practice the provider must inform the patient that CoCM care involves periodic reviews by specialists and that Medicare coinsurance applies to these non-face-to-face services. Written consent is not mandated (a recorded verbal consent is acceptable), but it must be documented in the record. 3 Note also that any qualifying face-to-face follow-up (e.g. a normal E/M or psychiatric visit) in the month should be billed separately and its time not double-counted for 99493. 1
CPT 99493 is billed under the Medicare Physician Fee Schedule by the billing practitioner. Use the standard national payment rate (facility or non-facility) for the code. Because 99493 is not on Medicare’s telehealth list, do not use modifier 95/GQ for Medicare FFS; report it with the usual POS code (see below). 1 3 The service period is the calendar month. A claim may be submitted after the end of that month, once the 60-minute threshold is met. Medicare coinsurance applies to 99493.
Most commercial payers follow similar rules but check each carrier’s policy. For example, some private plans may allow 99493 only under certain provider types or may require a telehealth modifier (e.g. 95) if services are delivered by video. During the COVID-19 public health emergency, many insurers and Medicaid programs explicitly permitted CoCM services via telehealth or phone, often without modifiers. State telehealth parity laws generally treat mental/behavioral health services (including CoCM) the same whether in-person or remote. In all cases, use the place-of-service where you would normally see the patient – typically POS 11 (office) even if the patient is at home or in a facility. (For example, Medicare will still reimburse 99493 if the patient was hospitalized; you simply report POS according to the practitioner’s usual practice location.) 3
Although 99493 involves non–face-to-face work, it is not classified as a Medicare telehealth service. This means under Medicare you do not append modifier 95 or use POS 02 solely because CoCM was delivered by phone/video. The code can be furnished remotely as part of a telehealth model, but billing is the same as if the care manager were working from the office. Always list the regular POS (office, outpatient hospital, etc.) where the billing provider sees the patient. Under Medicare rules, psychiatric consultants and care managers may consult or provide services remotely without restriction, provided a face-to-face visit is available in practice if needed. 1
For private insurers, telehealth rules vary. Many commercial payers now reimburse CoCM codes via telehealth (especially under parity laws), but some require the modifier (e.g. 95) or POS 02 to trigger telehealth billing. Check the payer’s mental health telemedicine guidelines. In any case, document the mode of contact. If calling a patient by phone, note the duration just as you would a video call. No special CoCM-specific modifier exists beyond 99492–94; 99493 is reported alone. During COVID-19, most plans waived restrictions, so practices could deliver CoCM entirely remotely if needed.
99492 (Initial CoCM): First calendar month of CoCM, ≥70 min of care manager time. 2 This must be billed before 99493 can be used in later months.
99494 (Add-on CoCM): Reported in addition to 99492 or 99493 for each extra 30 minutes beyond the base time. (For example, 90 total minutes in month = 99493 + 99494.) 1
General BHI – 99484: A separate 20-min-per-month code for behavioral health integration without a psychiatric consultant. You cannot bill 99484 and the CoCM codes in the same month for the same patient. 1 Choose the model that fits the practice (CoCM uses the 992 codes; if no consultant is involved, use 99484).
Chronic Care Mgmt (CCM): You can bill CCM codes (99490, 99491, etc.) in the same month as 99493 for the same patient, but only if the patient has given separate consent to CCM and all CCM requirements are met. 5 Likewise, Transitional Care Mgmt (99495/99496) can be billed in a CoCM month if appropriate. Just be careful not to count the same time toward both services.
Psychotherapy/Medication Visits: If the patient also sees the provider or a psychiatrist face-to-face for counseling or meds, those services are billed separately. Crucially, any minutes spent on direct patient encounters must not be counted toward the 99493 threshold. 1
Initial Encounter Requirement: If a patient is new to the practice (or hasn’t been seen in >1 year), one of the first CoCM service codes in a series must be preceded by a qualifying face-to-face visit (like an AWV, IPPE, or comprehensive E/M) where you document the care plan and consent for CoCM. 5 After that, CoCM can continue monthly without further required E/M visits.
Do not bill 99493 in the same month as 99484 for a given patient (you must pick CoCM or General BHI). 1
You can bill 99493 alongside a chronic care management or transitional care code if needed, provided the patient agreed to each service and you separate the time usage. 5
You can also provide regular evaluation-and-management or therapy visits in a CoCM episode; simply bill those visits normally and do not include that face-to-face time in the 99493 calculation. 1 Each E/M or psychotherapy service must have its own documentation and time tracking.
Using CPT 99493 can greatly benefit behavioral health practices. For clinicians, it provides reimbursement for intensive care coordination that was previously uncompensated. As one expert notes, the CoCM codes “offer a source of payment for that time spent coordinating care” that complements direct clinical work. 2 This revenue helps small practices hire trained care managers and consult with psychiatrists, making integrated care financially viable. For patients, collaborative care means systematic follow-up (regular outcome monitoring via PHQ-9, etc.), quicker treatment adjustments, and access to psychiatric expertise without waiting for a specialty referral. Studies show that CoCM improves outcomes in depression and other behavioral conditions. In short, CPT 99493 enables a team approach: it expands patient access to coordinated mental health care and gives clinicians a practical way to be reimbursed for the extra work of integrated care. 3 2
Key Takeaways: CPT 99493 is the subsequent month CoCM code (60 min), billed by the treating physician/NP/PA overseeing the care team. It requires extensive documentation of care management activities. 1 Medicare covers it both in-office and at facilities (use usual POS). 4 2 The code may be provided via telehealth without modifiers, but always verify each insurer’s rules. 99493 cannot be billed with general BHI (99484) in the same month 1, but it can be billed alongside chronic care or TCM codes if requirements are met. 5 In sum, 99493 lets mental health clinicians and primary care teams be paid for delivering structured, team-based care to patients with behavioral health needs.
Sources:
American Psychiatric Association - APA CoCM and General BHI FAQs https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/Integrated-Care/APA-CoCM-and-Gen-BHI-FAQs.pdf
American Medical Association - 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
Centers for Medicare & Medicaid Services (CMS) - MLN909432 - Behavioral Health Integration Services https://www.cms.gov/files/document/mln909432-behavioral-health-integration-services.pdf
Centers for Medicare & Medicaid Services (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
American Academy of Family Physicians (AAFP) - Coding for Behavioral Health Integration Services https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/behavioral-health-integration-coding.html
