CPT 99492: Psychiatric Collaborative Care — Initial 70 Minutes.
CPT 99492 covers the first calendar month of Psychiatric Collaborative Care Management (CoCM) — a structured, evidence-based behavioral health model integrating a behavioral health care manager (BHCM) and a consulting psychiatrist into primary care. The code reimburses 70 or more minutes of BHCM time in the initial month, including intake, validated screening, care plan development, weekly registry review with the psychiatric consultant, and patient outreach. CoCM is the highest-reimbursing behavioral health pathway in Medicare and is the recommended model when a practice has access to a consulting psychiatrist.
Quick Answer
What is CPT 99492?
CPT 99492 is the Medicare billing code for the initial calendar month of Psychiatric Collaborative Care Management (CoCM), reimbursing approximately $163 for 70+ minutes of behavioral health care manager time. CoCM requires a designated behavioral health care manager plus a consulting psychiatrist who provides weekly registry review. The model is the highest-reimbursing behavioral health pathway in Medicare and is the recommended approach when a practice has access to a consulting psychiatrist. Subsequent months bill 99493 (~$130); additional 30-minute increments bill 99494 (~$66).
Documentation
Documentation requirements.
Documented patient consent for CoCM services with explanation of the model and any cost-sharing
Baseline validated screening (PHQ-9 for depression, GAD-7 for anxiety) with documented score
Person-centered behavioral health care plan with measurable treatment goals and a planned reassessment cadence
Identification of the consulting psychiatrist participating in the patient's case
Time log totaling 70+ minutes in the initial month with BHCM activity descriptions
Documentation of at least one psychiatric consultation (typically weekly registry review)
Care coordination notes with primary care provider, patient, and any external behavioral health providers
Billing Workflow
How to bill 99492, step by step.
The calendar-month workflow a billing team actually runs — from qualifying the month to the increment math at month close.
Confirm the model before the first minute
CoCM requires a designated behavioral health care manager AND a consulting psychiatrist who participates in weekly registry review. If the psychiatric consultation is not in place, the month belongs to general BHI (99484) — logging 70 minutes does not make it CoCM.
Document consent for the model
The patient consents to CoCM with the model and any cost-sharing explained, and the consent is documented before billing starts. This is a per-episode requirement, not a formality that can be backfilled at claim time.
Screen and score at baseline
Administer validated instruments — PHQ-9 for depression, GAD-7 for anxiety — and put the numeric scores in the record. The scores feed a person-centered care plan with measurable treatment goals and a planned reassessment cadence.
Log BHCM time all month
Intake, patient outreach, care-plan work, registry preparation, and coordination all count toward the 70-minute initial-month threshold. Keep one per-activity log, separate from any CCM or RPM minutes for the same patient.
Hold — and document — the weekly registry review
The consulting psychiatrist reviews the caseload weekly. Each consultation is documented with the psychiatrist identified, the case presented, and the resulting recommendation. This is the element that separates CoCM from general BHI.
Do the month-close math
70 or more BHCM minutes: bill 99492. Each full additional 30 minutes beyond that: add one 99494 unit (100+ minutes total for the first). Under 70 minutes: 99492 is not billable that month.
Keep 99484 out of the same month
CoCM and general BHI are mutually exclusive within a calendar month for the same patient. Bill one model or the other — a claim carrying both is denied.
Scenarios
Common billing scenarios.
Standard initial month for moderate-to-severe depression
BillableA primary care patient screens PHQ-9 = 16 (moderately severe depression). The BHCM spends 80 minutes across the first month performing intake, administering GAD-7, building a care plan with the patient, presenting the case at the weekly psychiatric registry review, and following up by phone. Bill 99492 for the initial month.
BHCM time only — no consulting psychiatrist involved
Not BillableA practice provides 75 minutes of behavioral health care management for a depressed patient but has not yet engaged a consulting psychiatrist. The CoCM model is incomplete without psychiatric consultation. Bill 99484 (general BHI) instead of 99492.
CoCM initial month plus additional time
BillableA BHCM spends 105 minutes in the initial month managing a patient with major depression and PTSD — extra time was needed to coordinate with an external trauma therapist. Bill 99492 for the first 70 minutes and 99494 for the additional 35 minutes (30-minute increment).
Initial month + same-month general BHI
Not BillableA practice bills 99492 (CoCM initial month) and 99484 (general BHI) for the same patient in the same calendar month. These models are mutually exclusive within a month — bill one or the other.
Audit & Compliance
Audit rules & denial defense for 99492.
What a payer reviewer checks on a records request, the failure that triggers each denial, and the documentation that survives it.
Consent that names the model
Denial risk
A generic care-management consent that never mentions CoCM or cost-sharing fails the services-explained requirement.
What survives review
A dated consent note naming CoCM, the behavioral health care manager's role, the consulting-psychiatrist arrangement, and cost-sharing.
Baseline validated screening in the record
Denial risk
A narrative like 'patient appears depressed' with no PHQ-9 or GAD-7 score does not establish the evidence-based baseline the model requires.
What survives review
Instrument name, administration date, and numeric score at intake, with the reassessment cadence written into the care plan.
The psychiatrist actually consulted
Denial risk
A consulting psychiatrist named in the chart with no documented registry review reads as a paper arrangement — and the CoCM claim reverts to what general BHI would have supported.
What survives review
Weekly registry-review notes identifying the psychiatrist, the cases discussed, and the recommendations that came back.
70 minutes of BHCM time, substantiated
Denial risk
Initial-month claims whose log re-adds to under 70 minutes are downcoded or denied outright — there is no partial credit at 65.
What survives review
A per-activity BHCM time log that recomputes past 70 minutes, kept separate from CCM and RPM minutes for the same patient.
One behavioral model per month
Denial risk
99492 and 99484 billed in the same calendar month for the same patient is a mutual-exclusivity denial.
What survives review
A claim-scrub rule that blocks same-month CoCM and general-BHI lines from ever leaving the practice.
FAQ
Common questions about CPT 99492.
What is CPT 99492?
CPT 99492 is the Medicare billing code for the initial calendar month of Psychiatric Collaborative Care Management (CoCM), covering 70 or more minutes of behavioral health care manager time. CoCM is a structured model integrating a designated behavioral health care manager and a consulting psychiatrist into primary care to manage behavioral health conditions like depression and anxiety. It reimburses approximately $163 per initial month under the 2026 Medicare fee schedule.
How much does CPT 99492 reimburse in 2026?
CPT 99492 reimburses approximately $163 per patient for the initial CoCM month under the 2026 Medicare Physician Fee Schedule. This is the highest behavioral health reimbursement available under standard PFS codes. Subsequent months (99493) reimburse approximately $130, and additional 30-minute increments (99494) add approximately $66.
What is the difference between 99492 and 99484?
99492 requires the full CoCM model — a behavioral health care manager AND a consulting psychiatrist, weekly registry review, and 70+ minutes in the initial month. 99484 (general BHI) requires only 20 minutes of clinical staff time and does not require a consulting psychiatrist. CoCM reimburses about 3× more but requires more infrastructure. Practices without psychiatric consultation typically bill 99484.
Do I need a psychiatrist on staff to bill 99492?
Not on staff, but the practice must have access to a consulting psychiatrist who participates in the weekly registry review of CoCM patients. The consulting psychiatrist does not need to see patients directly — their role is to provide caseload-level expert input to the behavioral health care manager and the treating physician. Many practices contract this consultation rather than employing the psychiatrist.
Can CoCM be billed alongside RPM or CCM?
Yes. CoCM codes (99492/99493/99494) can be billed concurrently with RPM (99454/99457) and CCM (99490) for the same patient in the same month, provided the time and clinical activities are distinct. A patient with diabetes, hypertension, and major depression could generate RPM + CCM + CoCM revenue, with each program's time tracked separately. CoCM cannot be billed in the same month as general BHI (99484).
What screening tools are required for 99492?
CMS requires validated, evidence-based instruments — the most common are PHQ-9 (depression severity, 9 items) and GAD-7 (anxiety severity, 7 items). Both should be administered at baseline and at regular intervals (typically monthly) to demonstrate treatment response. Practices managing substance use disorders should additionally use AUDIT-C or DAST-10. Tool selection and scoring must be documented in the patient record.
Related Codes
Other CPT codes.
CCM Initial 20 Minutes
$62.00 • Once per calendar month
RPM Device Supply (16+ Days)
$52.11 • Monthly (per 30-day period)
RPM Clinical Review (First 20 Min)
$51.77 • Once per calendar month
RPM Initial Setup (One-Time)
$21.71 • One-time per episode of care
RPM Clinical Review (Additional 20 Min)
$41.42 • Monthly (per calendar month, add-on to 99457)
Complex CCM Initial 30 Minutes
$86.00 • Once per calendar month
PCM Physician Base (30 Min)
$88.00 • Once per calendar month
BHI Care Management (20 Min)
$53.00 • Once per calendar month
CoCM Subsequent Month (60 Min)
$130.00 • Monthly, in each month after the initial 99492 month
CoCM Add-On (Each 30 Min)
$66.00 • As needed, in 30-minute increments, in the same month as 99492 or 99493
Complex CCM Add-On (Each 30 Min)
$63.00 • Monthly, as needed, in addition to the base 99491
CCM Add-On (Each 20 Min)
$50.00 • Up to 2 units per calendar month, in addition to the base 99490
Sources & Compliance
CPT® notice. CPT is a registered trademark of the American Medical Association. CPT codes, descriptions, and other data only are copyright 2026 American Medical Association. All rights reserved. CPT is provided “as is” without warranty of any kind. The plain-language descriptions, billing scenarios, and FAQs on this page are CCN Health’s editorial summary and are not the official AMA long descriptors.
Reimbursement. Reimbursement figures shown are CCN Health estimates based on the CMS Medicare Physician Fee Schedule (CY 2026) using published RVU values and the 2026 conversion factor of $33.40. Final payment varies by locality (GPCI), facility status, and payer contract. Fee schedules, relative value units, and conversion factors are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.
Sources. CMS Medicare Physician Fee Schedule, CY 2026 (cms.gov); AMA CPT 2026 Code Set (ama-assn.org).
Disclaimer. This page is informational and does not constitute billing, clinical, or legal advice. Verify all codes, modifiers, and reimbursement amounts against your contracted payer agreements and the official CMS publications before billing.