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  • PDCM Billing Codes
    • G9001: Comprehensive Assessment
    • G9002: Maintenance
    • 98966-98968: Telephonic
    • 99487, 99489: Care Coordination (without patient)
    • G9007: Team Conference
    • 98961, 98962: Group Education
    • G9008: Care Oversight
    • S0257: Counseling Regarding Advance Directives
    • PDCM Reference Materials
    • PDCM FAQs
  • CoCM Billing Codes
    • Collaborative Care Services
    • General Behavioral Health Integration
    • CoCM Reference Materials
    • CoCM Billing FAQs

Collaborative Care (CoCM) Services

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

Provider
Location
Service Code Billing
Allowances
Minimum
Time
Threshold
                               Payable Groups - Requirements

Commercial
(BCBSM, BCN,
Priority Health, HAP)

Medicare Medicare
Advantage
Medicaid                       
Non FQHC/RHC CoCM 99492 Initial Month 36-70
minutes
*BCBSM/BCN service lines -
 No member cost sharing

Initial visit must be
face-to-face or via dual audio-visual telemedicine

After the initial 12 months of treatment, prior authorization is required for an additional 12 months of treatment.   If no improvement occurs after the initial 12 months or condition worsens, the individual is to be referred to specialty services

Not billable if CoCM patient is receiving MI Care Team, Behavioral Health Home, or Opioid Health Home benefits

G2214* Any Month 16-30
minutes
99493 Subsequent Month 31-60 minutes    
99494 Add- on Code 16-30 minutes Not Billable
FQHC/RHC Chronic Care Management/
General Behavioral Health
G0512 Initial Month 70 minutes   Medicare beneficiaries are responsible for the 20% coinsurance.  
Subsequent Month 60 minutes      

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:

Time Spent Activities
Initial Month ≤10 minutes Not Billable
11-35 minutes 99484 – Gen BHI
36-85 minutes 99492
16-30 minutes G2214
86-115 minutes 99492 + 99494
116-130 minutes 99492 + 99494, quantity 2 units
Subsequent Month(s) ≤10 minutes Not Billable
≤16-30 minutes G2214
≤31-75 minutes 99493
≤76-105 minutes 99493 + 99494
≤106-135 minutes 99493 + 99494, quantity 2 units
Michigan Institute for Care Management and Transformation
2500 Green Rd, Suite 100
Ann Arbor, MI 48105

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