Collaborative Care (CoCM) Services

Please use the recommended billing reference materials provided by the PRISM team. We also strongly encourage to watch the billing webinar for additional information. 

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.  This code may only be billed once per calendar year.

G2214* - Initial or subsequent psychiatric collaborative care management, first 30 minutes in a 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.

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.

99494 (add-on code) - Initial or Subsequent Psychiatric Collaborative CM; 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)

Description: Collaborative care activities with behavioral health care managers, psychiatric consultants and treating physicians

Delivery Method: Face-to-face, telephone or video

Billing opportunities and reimbursement may vary depending upon organization's specific payer value-based contracts. All services should be billed in accordance with CPT and Center for Medicare & Medicaid service guidelines.

MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors. 

_{*G2214 - Initial or subsequent psychiatric collaborative care management
*BCBSM/BCN service lines - No member cost sharing}

Recommended EMR Documentation:

Templates available here

• Behavioral Health Care manager responsible for overall care plan, his/her credentials, and patient’s provider and contact information
• Patient Consent
• Date, duration, and modality of contact (face-to-face or video)
• Name and relationship of person contacted if other than patient
• Assessment, treatment plan – including evidence-based interventions
• Referrals if appropriate
• Medication Management

Activities Include: 

• Advanced Consent:
  • Verbal or written, must be documented in the EHR
  • Permission to consult with relevant specialists (i.e., psychiatric consultant)
  • Inform the patient of cost sharing
• Outreach to engagement in treatment of a patient directed by the treating physician or QHP
• Initial assessment of the patient including administration of validated rating scales (e.g., PHQ-9 or GAD-7), with the development of treatment plans
• Review by the psychiatric consultant with modifications of the plan
• Enter patient in registry and track follow-up and progress using the registry, documentation, and participation in weekly caseload consultation with consultants. 

Scenario: