CPT 99494: Psychiatric Collaborative Care Add-On for Behavioral Health

CPT 99494 is an add-on code for Psychiatric Collaborative Care Management (CoCM) in behavioral health integration. It represents each extra 30 minutes of care manager activity in a month, billed only with 99492 or 99493. ¹ ² In practice, a patient in a collaborative care program has a primary (billing) provider who leads a team with a behavioral health care manager and a consulting psychiatrist. ³ Code 99494 is used when the care manager’s cumulative time exceeds the base 70 minutes (first month) or 60 minutes (subsequent months) of CoCM time. For example, a care manager who spends 90 total minutes in the first month would trigger 99492 (70 minutes) plus one unit of 99494 (the extra 30 minutes).pdf#:~:text=Care%20management%20services%20for%20behavioral,progressing%20or%20whose%20status%20changes). By design, 99494 cannot stand alone; it only augments 99492/99493 in the same calendar month. ¹ ² ³

Who Can Bill 99494 and in What Settings

Medicare and major payers stipulate that the billing practitioner for CoCM codes must be a physician or Medicare-recognized non-physician practitioner (NP, PA, CNS, CNM) who can independently bill E/M services. Typically this is a primary care provider or other physician overseeing the patient’s overall care. Psychiatrists and other specialists usually serve as the consultant in CoCM rather than the billing provider, so they rarely bill 99494 themselves. ⁴ In a small or private practice with integrated care, the lead clinician (often the PCP) would bill CoCM codes and direct the behavioral health team. The behavioral health care manager can be a licensed professional with formal training in mental health (social worker, psychiatric nurse, psychologist, etc. ³ Mental health clinicians (e.g. licensed therapists or case managers) often fill that care-manager role under the provider’s supervision, but only the billing practitioner submits CPT 99494.

In terms of settings, 99494 is intended for outpatient, team-based care programs. It is billed by the treating practitioner as part of an ongoing CoCM care plan. Federally qualified health centers (FQHCs) and rural health clinics (RHCs) use a different code (HCPCS G0512) to capture the core CoCM service; however, when an FQHC or RHC employs 99492/99493 (or G0512), 99494 can be used to report add-on time as needed. ² In all settings, the care manager’s time and psychiatric consultation must be documented under the direction of the billing provider. Essentially, any practice (large or small) that implements a CoCM team – whether in a health system, private clinic, or FQHC – can bill 99494 so long as the service requirements are met.

Time Tracking and Documentation Requirements

CPT 99494 is time-based: it requires each full 30-minute interval of care management beyond the initial code threshold. ³ The care manager’s minutes should be totaled across the calendar month. For example, if the care manager spends 100 minutes in month two (exceeding the 60-minute base), the provider would bill 99493 (60 minutes) plus one unit of 99494 (30 minutes).¹ ³ Minutes must be carefully tracked and documented; CMS emphasizes that these minutes are cumulative (spread over multiple contacts or activities during the month) rather than all in one visit. ²

Documentation should reflect all required CoCM elements. This includes an initiating visit for any new patient or any patient not seen within a year before starting CoCM (this could be a preventive or diagnostic evaluation such as an AWV, 90791, or other qualifying E/M). The medical record must show systematic assessment (e.g. PHQ-9 or other validated scales) and an individualized care plan with ongoing monitoring. The care manager’s notes should document patient engagement, outreach, brief psychosocial interventions (e.g. behavioral activation, motivational interviewing), and coordination of care. Crucially, records must include evidence of regular case reviews with the psychiatric consultant (often weekly or biweekly). In addition, patient consent (verbal or written) for collaborative care and cost-sharing must be obtained and noted in the chart. This means the patient is informed about the program, psychiatric consult component, and any applicable copay/coinsurance for the CoCM service. ³ ⁵ ⁶

Billing Rules and Payer Considerations

Code 99494 is an add-on; it may only be billed once for each additional 30 minutes beyond the primary code’s threshold in the same month as 99492 or 99493. ² For example, if a care manager logs 130 minutes in month one, the billing practitioner would report 99492 (70 min) plus two units of 99494 (additional 60 min). Note that 99494 can be used in the first month (with 99492) or any subsequent month (with 99493) of a patient’s CoCM episode. ¹ ^{21](#sources)}

Medicare treats CoCM as a separate benefit. The billing provider must direct the care manager and pay for psychiatric consultation; Medicare then reimburses the provider under Part B. CoCM codes (99492–99494) cannot be billed in the same month as General BHI code 99484 for the same patient. However, CoCM may be billed in the same month as Chronic Care Management (CCM) or Transitional Care Management (TCM), provided all requirements (independent documentation, separate consents, no double-counting of time) are met. Providers may also bill separately for any face-to-face E/M or psychotherapy they deliver to the patient on the side, as long as those visits are distinct and not counted in the CoCM time. ⁶

Payer coverage for 99494 varies. CMS’s Physician Fee Schedule covers these CoCM codes; Medicare coinsurance applies each month and beneficiaries must give consent each year. Many commercial insurers and state Medicaid programs now cover CoCM services as well. For example, insurers like Aetna, Cigna, Humana, and many Blue Cross/Anthem plans have publicly indicated coverage for CPT 99492–99494. ⁶ State Medicaid coverage differs by state (several states reimburse CoCM under Medicaid, sometimes with specific limits or telehealth rules). Practices should verify with each payer; some plans limit the number of times 99494 can be billed (e.g. Maryland Medicaid recommends a maximum of two units per month unless medically necessary). ² Importantly, psychiatrists rarely bill these codes directly – they participate as consultants – so most payer policies expect a primary care provider or similar practitioner to submit the claim. ⁶ (Specialty behavioral health clinicians can bill the new general BHI code G0323/99484 under supervision, but that is outside CPT 99494’s scope.)

Telehealth Use (Modifiers, POS, Parity)

Medicare has not added the CoCM codes to its permanent telehealth list, so under current CMS rules these codes generally require an in-person or non-telehealth encounter with the patient (e.g. POS 11 or 10 without telehealth modifiers). In other words, Medicare beneficiaries typically must have an actual visit to their primary provider before billing CoCM codes. ⁷ Commercial insurers and state Medicaid plans vary widely. Many Medicaid agencies and private plans allow CoCM services to be delivered via telehealth (audio-visual or even telephone) with the appropriate modifiers. For example, Maryland Medicaid explicitly allows 99492–99494 with modifier GT for video telehealth, and with modifier UB for audio-only telephone delivery. ² Minnesota Medicaid requires modifier 93 (real-time interactive) for these codes when provided remotely. New York Medicaid permits 99492–99494 with POS 02/10 and modifier 95 (or 93) for telehealth. ⁸ Many commercial plans follow similar rules: they may require modifier 95 (synchronous telemedicine) or GT, and the telehealth place of service. It’s essential to confirm each payer’s telehealth billing policies. State parity laws increasingly mandate that telehealth mental health services be reimbursed at the same rate as in-person, but specific application to care management codes depends on the insurer.

Relation to 99492 and 99493, and Other Services

99494 is part of the CoCM code family. In a new episode, CPT 99492 covers the first 70 minutes of care manager time (in month one), while 99493 covers the first 60 minutes in each subsequent month. After the initial threshold is met, 99494 is used to capture each extra half-hour per month. ¹ (CMS also created HCPCS G2214 for each first 30 minutes of a month, but that code is distinct and is typically used when the total time falls below 60 minutes.) By design, you cannot bill more than one 99492 or 99493 in a month; any additional time must be reported with 99494 units.

CoCM codes are incompatible with general BHI (99484) in the same month for the same patient. ⁶ However, they can be used alongside other care management or preventive services. For instance, a patient can receive an Annual Wellness Visit or Welcome to Medicare visit as the initiating visit for CoCM. ⁵ A physician can also bill CCM (for non-psychiatric chronic conditions) in a month they bill CoCM, as long as patient consent is obtained separately and the time is not double-counted. Importantly, any face-to-face encounters (office visits, therapy sessions, psychiatric evaluations) that the consultant or provider has with the patient on unrelated issues can be billed separately; CMS clarifies that all providers “can bill separately for face-to-face services… so long as this time is not included” in the CoCM time calculation. ⁶

Value of 99494 for Clinicians and Patients

For behavioral health practices, CPT 99494 (with 99492/99493) enables payment for intensive care management that was previously uncompensated. By reimbursing the time of care managers and consultants, these codes help sustain integrated care models. Clinicians can hire or contract with a care manager and psychiatric consultant while recouping most of those costs through billing. From the patient perspective, CoCM services (and 99494) support better outcomes and satisfaction. A large Cochrane review found collaborative care markedly improves depression and anxiety outcomes and patient satisfaction compared to usual care. ⁹ CMS also notes that CoCM “enhances usual primary care by adding care management support and regular psychiatric consultation,” a team approach shown in studies to improve outcomes. ³ In short, 99494 adds value by covering additional 30-minute blocks of coordinated care each month – helping practices to deliver deeper mental health support while getting fairly reimbursed for that extra work. This revenue can be reinvested in staff and resources (e.g. tracking registries, validated screening tools, telemonitoring systems) that benefit patients.

Key Takeaways: CPT 99494 is an add-on code for Collaborative Care Management, billable only with 99492/99493, for each extra 30 minutes of care manager time per month. ¹ ² It must be billed by an eligible provider (MD/NP/PA, etc.) leading a CoCM team. ⁶ Strict documentation of time, care activities, consultant oversight, and patient consent is required. ³ ⁵ Be sure to follow payer rules: CoCM codes can’t be combined with general BHI (99484) in a month ⁴, but are allowed with CCM or TCM if criteria are met. ⁶ Telehealth billing varies by state/payer (modifiers GT/95/93, POS 02/10). ² ⁸ Proper use of 99494 helps behavioral health teams secure funding for intensive, evidence-based integrated care, yielding improved patient outcomes. ³ ⁹

Sources:

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
Maryland Department of Health - Medicaid Coverage of Collaborative Care Model Services https://health.maryland.gov/mmcp/Documents/Provider%20Transmittals/PT%2071-24%20Superseding%20Guidance%20-%20Medicaid%20Coverage%20of%20Collaborative%20Care%20Model%20Services%20HealthChoice%20and%20FFS.pdf
Centers for Medicare & Medicaid Services (CMS) - MLN909432 - Behavioral Health Integration Services https://www.cms.gov/files/document/mln909432-behavioral-health-integration-services.pdf
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 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
American Psychiatric Association - Coverage for Psychiatric Collaborative Care Management (CoCM) Codes https://www.psychiatry.org/getmedia/c2b57396-00a3-4d46-90db-7bf3414014d3/Coverage-Psychiatric-CoCM-Codes-Payers.pdf
Powers Law - Changes to Telehealth, Behavioral Health Integration, and Remote Monitoring Services Under CY 2023 Medicare Final Rule https://www.powerslaw.com/changes-to-telehealth-behavioral-health-integration-and-remote-monitoring-services-under-the-cy-2023-medicare-physician-fee-schedule-final-rule
UnitedHealthcare - Telehealth/Virtual Health Policy - UnitedHealthcare Community Plan https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-Telehealth-Virtual-Health-Policy-Professional-and-Facility-R7133.pdf
Cochrane - Collaborative care for people with depression and anxiety https://www.cochrane.org/CD006525/DEPRESSN_collaborative-care-for-people-with-depression-and-anxiety