CPT 99492: Initial Psychiatric Collaborative Care Management

Mukesh MakwanaFounder & CEO · 8+ years hands-on in medical billing & RCM · Reviewed September 29, 2026

CPT 99492 is not a visit code. It is a monthly bundle billed by a primary care or treating practice for behavioral health work done largely by other people, and it only pays when the whole model is in place. Practices that treat it as a way to bill for talking to a psychiatrist find out at the first audit that almost none of the required elements were documented.

What CPT 99492 covers

99492 is 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.

Three people are in that descriptor, and all three have to exist:

• The treating practitioner, who bills the code, directs the care and keeps overall responsibility for the patient.
• The behavioral health care manager, whose time is what the 70 minutes measures. This person does not have to be someone who could independently bill Medicare, but administrative and clerical time never counts.
• The psychiatric consultant, a psychiatrist or other qualified professional who reviews the caseload weekly and advises on the plan, usually without ever seeing the patient.

The required elements, in full

CMS lists these as required, not recommended. Missing one is enough to lose the claim:

• Outreach to and engagement in treatment of the patient, directed by the treating practitioner.
• Initial assessment of the patient, including administration of validated rating scales, with the development of an individualised treatment plan.
• Review by the psychiatric consultant, with modifications to the plan if recommended.
• Entering the patient in a registry and tracking follow-up and progress using it, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant.
• Provision of brief interventions using evidence-based techniques such as behavioral activation and motivational interviewing.

CPT 99492 billing guidelines: time, and which month it belongs to

The threshold is 70 minutes of behavioral health care manager time per calendar month. CMS's own coding summary shows an assumed 30 minutes of billing practitioner time inside that value, but the 70 minutes is the care manager's.

Two points cause most of the trouble:

• Calendar month, not rolling 30 days. Time does not carry across a month boundary. An episode that starts on the 25th will usually not reach 70 minutes before the month ends, and the correct answer is to bill the first month in which the threshold is actually met, not to split the total.
• 99492 is the first month only. Subsequent months are 99493 at 60 minutes. Medicare's edits pair 99492 against 99493 with a modifier indicator of 0, so the two never appear on one month's claim.

Where the care manager exceeds the threshold, 99494 adds each additional 30 minutes in the month and may be reported with either 99492 or 99493.

What changed for 2026

CMS finalised three optional add-on codes for Advanced Primary Care Management, G0568, G0569 and G0570. G0568 is the add-on based on 99492, G0569 is based on 99493, and G0570 is based on 99484 for general behavioral health integration. CMS describes them as directly comparable to the existing CoCM and BHI codes.

The trigger is APCM. Where the same practitioner reports an APCM base code for the patient in the same month, the collaborative care work is reported with the add-on rather than with 99492. Where the practice is not billing APCM, 99492 remains the code. The 2026 change adds a path, it does not remove one, and the widely repeated claim that the CoCM CPT family was replaced by G codes is simply wrong.

These codes also reach federally qualified health centres and rural health clinics, which may report G0568, G0569 or G0570 when they integrate behavioral health with APCM services.

Consent and cost sharing

Before collaborative care begins, the beneficiary has to give the billing practitioner permission to consult with relevant specialists, including the psychiatric consultant. The practitioner must also tell the patient that cost sharing applies to both face-to-face and non-face-to-face services. Consent may be verbal, written consent is not required, but it must be documented in the medical record.

That cost-sharing conversation is worth doing properly. A patient who did not expect a monthly charge for a service involving no appointment is a patient who calls the practice, and then stops engaging.

Documentation requirements

• Documented advance consent, including the cost-sharing disclosure, with the date.
• An initiating visit in the appropriate window: an annual wellness visit, initial preventive physical examination, transitional care management, or another qualifying evaluation and management visit.
• A time log of behavioral health care manager activity, by date and activity, totalling the month.
• Validated rating scale results at baseline and over time, with the instrument named.
• Registry entry and evidence of tracking, not merely a statement that a registry exists.
• Dated records of weekly caseload consultation with the psychiatric consultant, and the recommendations that came out of them.
• The individualised treatment plan and any modifications the consultant recommended.
• The episode boundary, since an episode ends when treatment goals are met, on referral to direct psychiatric care, or after six consecutive months without collaborative care.

Common denials and the exact fix

Modifier rules

• No component modifiers. CMS gives 99492 a PC/TC indicator of 0, so 26 and TC never apply.
• No telehealth modifier in the ordinary case. Collaborative care is a monthly non-face-to-face bundle rather than a telehealth encounter, so it is not billed with 95 or 93 for the care manager's calls.
• Place of service is where the billing practitioner would ordinarily provide face-to-face care to the patient, which is a common source of error in practices that bill CoCM from a central location.
• 59 and the X modifiers will not release the 99484 or 99493 pairs, which carry a modifier indicator of 0.

Supervision

Collaborative care work not personally performed by the billing practitioner falls under general supervision on the physician fee schedule. The service is furnished under the practitioner's overall direction and control, and their physical presence is not required. General supervision does not by itself create the qualifying relationship between the billing practitioner and the rest of the care team, so the employment or contractual arrangement still has to stand up.

NCCI bundling edits

From the Medicare practitioner procedure-to-procedure file effective October 1, 2026.

• 99492 with 99484: indicator 0. Collaborative care and general behavioral health integration cannot both be billed for the same month.
• 99492 with 99493: indicator 0. The initial month and a subsequent month are mutually exclusive.
• 99492 with 96127: indicator 0.
• 99492 with 97151, 97153, 97155 or 97156: indicator 1, so adaptive behavior services may be separately reportable where genuinely distinct.
• 99494 is the add-on for each additional 30 minutes and is reported with 99492 or 99493, not in place of them.

Medicare's medically unlikely edit allows one unit of 99492 per patient per day, set as a policy edit on the basis of the code descriptor.

What CPT 99492 pays

Most of the value in 99492 is practice expense rather than physician work, which is what makes the setting matter so much: the non-facility total is close to double the facility total, because in a facility the care management infrastructure is assumed to belong to the facility. Place of service should be where the billing practitioner would ordinarily provide face-to-face care, not where the care manager happens to sit. Medicare publishes relative values rather than a price, so use the CMS look-up tool linked below for your locality, and remember that a collaborative care programme earns per enrolled patient per month, which is what makes the month boundary rule worth getting right.

2026 Medicare RVUs for CPT 99492

Source: CMS CY 2026 PFS Relative Value File, RVU26D (October release, published 08/26/2026). RVUs are national and unadjusted; commercial and Medicaid payers set their own rates and their own coverage.

In the 2026 CMS relative value file, CPT 99492 carries 1.88 work RVUs, with 4.80 total RVUs in a non-facility setting and 2.46 in a facility. The gap is practice expense: in an office the practice carries it, in a facility the facility does. Its PC/TC indicator is 0: CMS treats it as a physician service, so modifiers 26 and TC do not apply to it in any setting. Its global indicator is XXX: the surgical global period concept does not apply, so there is no postoperative period bundling other services into it. Across the collaborative care codes, work RVUs run from 0.82 (99494) to 2.05 (99493); 99492 sits at 1.88.

Units per day. Medicare's medically unlikely edit allows 1 unit of CPT 99492 per patient per day (a date of service edit set by policy, rationale: code descriptor / CPT instruction). A second unit on the same date will not pay. MUE values are published quarterly in the Medicare NCCI practitioner services MUE table; the value above is from the table effective October 1, 2026.

To turn RVUs into payment, each component is multiplied by your locality's geographic practice cost index, the three are added, and the sum is multiplied by the 2026 conversion factor: $33.4009, or $33.5675 for qualifying APM participants (CMS-1832-F; CMS fact sheet). The CMS Physician Fee Schedule Look-Up Tool runs that calculation for your own locality.

Frequently asked questions

Sources

American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release, published 08/26/2026): RVUs, PFS status indicator, PC/TC indicator and global indicator for 99492.
Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, CMS-1832-F: conversion factors.
Centers for Medicare & Medicaid Services, Medicare NCCI Practitioner Services medically unlikely edit table, effective October 1, 2026.
Centers for Medicare & Medicaid Services, Medicare NCCI procedure-to-procedure edits for practitioner services, 2026 Q4 file effective October 1, 2026.
Centers for Medicare & Medicaid Services, MLN booklet Behavioral Health Integration Services (MLN909432): full code descriptors, required care team elements, advance consent and the care manager time thresholds.
Centers for Medicare & Medicaid Services, MLN Matters MM14315, Medicare Physician Fee Schedule Final Rule Summary CY 2026.

CPT® is a registered trademark of the American Medical Association. Payer policy, NCCI edits and MUE values change quarterly, so check your own contractor and your commercial contracts before submission. How we verify this guidance.

Related codes

• CPT 90791. The diagnostic evaluation, billed per encounter rather than per month, and by the behavioral health clinician.
• CPT 90837. Session-based psychotherapy, the model collaborative care sits alongside rather than replaces.

Related reading

• Behavioral health & psychiatric billing. How we scrub session-based claims, track prior authorization and bill collaborative care.
• 2026 behavioral health code changes. What the CY 2026 fee schedule changed for collaborative care, digital mental health and telehealth.
• Provider credentialing & payer enrollment. A behavioral health claim only pays in network once the clinician is enrolled and effective.
• Behavioral health prior authorization in 2026. Why authorizations lapse mid-episode and what catching them early is worth.