Collaborative Care billing codes 99492, 99493, 99494 and G2214, explained

What CoCM billing pays for

Collaborative Care is a team model for patients with a behavioral health condition. The treating practitioner (often a primary care physician or nurse practitioner) directs care and bills. A behavioral health care manager follows the patient between visits. A psychiatric consultant reviews the caseload and advises. The team tracks every patient in a registry and measures progress with validated rating scales such as the PHQ-9 and GAD-7.

The codes are billed once per calendar month, and what you can bill depends mostly on how many minutes the care manager spent on the patient that month.

The four codes

How the minute thresholds work

CoCM codes are time based. Under the CPT time rule, a block of time is met once more than half of it has passed. That is why 99492 (a 70-minute block) is reportable from 36 minutes and 99493 (a 60-minute block) from 31 minutes. The add-on 99494 covers each further 30 minutes and is reportable once 16 minutes of that extra block have passed.

• A first month with 40 care-manager minutes supports 99492.
• A first month with 90 minutes supports 99492 plus one unit of 99494.
• A later month with 45 minutes supports 99493.
• A later month with 20 minutes falls short of 99493. For Medicare, it can support G2214 instead.

What Medicare expects before you bill

• An initiating visit. The billing practitioner sees the patient first to establish the relationship, unless they saw the patient recently.
• Consent. The patient agrees to Collaborative Care. Verbal consent is enough if you document it. A new consent is needed only if the billing practitioner changes.
• A registry and validated rating scales. Each patient is entered in a registry and followed with validated scales.
• Psychiatric consultation. The care manager reviews the caseload with the psychiatric consultant regularly.
• No double counting. General behavioral health integration codes are not billed in the same month as CoCM codes for the same patient.

Where Asendar™ fits

Asendar logs care-manager minutes per patient per calendar month and shows which code the month supports so far (99492, 99493, 99494 or G2214), using the thresholds above. At month end it produces a billing packet as CSV and PDF. Billing decisions remain the clinic's responsibility.

Common questions

What is the difference between 99492 and 99493?

99492 is the first month a patient is in Collaborative Care and covers the first 70 minutes of care-manager time. 99493 is every later month and covers the first 60 minutes.

How many minutes do I need to bill 99492?

Under the CPT time rule, 99492 is reportable once more than half of its 70-minute block has passed, which is 36 minutes in the calendar month.

When can I add 99494?

99494 is an add-on to 99492 or 99493 for each additional 30 minutes. Each unit is reportable once 16 minutes of that extra block have passed: from 86 minutes in a first month and from 76 minutes in a later month.

What is G2214?

G2214 is a Medicare code for the first 30 minutes of Collaborative Care in a first or later month. It is reportable from 16 minutes and is not billed in the same month as 99492, 99493 or 99494.

Do I need written consent for Collaborative Care?

Not for Medicare. Verbal consent is enough if it is documented. Other payers may differ.

Source

Centers for Medicare & Medicaid Services, Behavioral Health Integration Services (MLN909432). Medicaid and commercial payers set their own rules, which can differ from Medicare's. Check your payer before you bill. Billing decisions remain the clinic's responsibility.