Billing Codes for Psychiatric Collaborative Care Management

What is Collaborative Care Management (CoCM)? 

Psychiatric Collaborative Care Management (CoCM) is typically provided by a primary care team consisting of a primary care physician and a care manager who collaborate with a psychiatric consultant, such as a psychiatrist. The primary care team directs care and includes structured care management with regular assessments of clinical status using validated tools and treatment modification as appropriate. The psychiatric consultant provides regular consultations with the primary care team to review the clinical status and care of patients and to make recommendations.

Billing Codes for Psychiatric Collaborative Care Management

CPT Code 99492

Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements:

• Outreach to and engagement in the treatment of a patient directed by the treating physician or other qualified health care professional; 
• Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; 
• Review by the psychiatric consultant with modifications of the plan if recommended;
• Entering patients in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, participation in weekly caseload consultation with the psychiatric consultant, and
• Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies.

CPT Code 99493

Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements:

• Tracking patient follow-up and progress using the registry, with appropriate documentation;
• Participation in weekly caseload consultation with the psychiatric consultant; 
• Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; 
• Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant;
• Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; 
• Patient outcomes are monitored using validated rating scales, and relapse prevention plans are developed with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.

CPT Code 99494

Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure). (Use 99494 in conjunction with 99492 and 99493).

Calculation of Time

The billing of these codes is based on how much time the behavioral health care manager spends doing clinical work (face-to-face and non-face-to-face) with the patient. The CPT “Time Rule” applies to these services, which means that the service can be billed when the midpoint of the stated time has passed. Payer policies vary, and services in an FQHC and RHC differ.

CPT Code 99484

CMS created a code to describe general care management services for patients with behavioral health conditions, incorporating some but not all of the principles associated with collaborative care. The service can be billed once you reach at least 20 minutes of clinical staff time. Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

• Initial assessment or follow-up monitoring, including the use of applicable validated rating scales; 
• Behavioral health care planning concerning behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; 
• Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling, and/or psychiatric consultation; and 
• Continuity of care with a designated member of the care team.

Billing Services in FQHC and RHC

CMS has incorporated the payment for FQHCs and RHCs into two HCPCS codes. When billing for the general care management service and care management for behavioral health conditions – use G0511, and when billing for Collaborative care services, use G0512. FQHCs and RHCs do not recognize the CPT time rule or add-on code for additional time. You must provide the full 70 (initial) or 60 (subsequent) minutes before billing for the service, and sites are not paid for additional time. You must review the specific requirements associated with billing in these settings. 

We shared billing codes for Psychiatric Collaborative Care Management, but that’s not enough. You might face many other billing questions while billing for Psychiatric Collaborative Care Management, such as: Who bills for these services? Who can play the behavioral health care manager role? What are his qualifications? What are the qualifications for a psychiatric consultant? How do I get paid as a psychiatric consultant? Who can provide BHI services? 

There is a more straightforward solution; contact us for your billing and coding requirements, and our Psychiatric Billing experts will handle it all for you. Medical Billers and Coders (MBC) can streamline your billing and coding functions and can improve insurance reimbursements. Our expert medical billers and coders can help streamline your billing and coding processes, such as eligibility and benefits verification, prior authorizations, charge entry, claim submissions, payment posting, denial handling, accounts receivable management, medical coding, and provider credentialing. To learn more about our commitment to excellence and performance for medical practices and healthcare providers, contact us at info@medicalbillersandcoders.com/ 888-357-3226.

FAQs