CPT code 99492 – Psychiatric collaborative care management, first month

Key takeaways

CPT code 99492 bills the first calendar month of psychiatric collaborative care management, once per episode of care.

The descriptor states 70 minutes, but the CPT time rule lets you bill once 36 care manager minutes are documented.

The treating physician or nonphysician practitioner bills the claim, not the care manager or the psychiatric consultant.

Without a documented psychiatric consultant review, a 99492 claim is unlikely to survive an audit.

Time cannot be counted toward both CCM (99490) and CoCM in the same month, and payer rules vary, so check before billing both.

Medicare pays approximately $160 for 99492 in 2026, before locality adjustment.

CPT code 99492 pays for the first month of collaborative care

CPT code 99492 is the billing code for the first calendar month of psychiatric collaborative care management, or CoCM. A care manager delivers the work, a psychiatric consultant advises, and the treating physician or nonphysician practitioner (NPP) directs the plan and bills.

The AMA CPT code set describes the code as the initial month of this team-based care. Its descriptor names 70 minutes of behavioral health care manager (BHCM) activity and five required elements:

• Outreach to the patient and engagement in treatment, directed by the treating clinician.
• An initial assessment with validated rating scales, ending in an individualized treatment plan.
• Review by the psychiatric consultant, with plan changes if recommended.
• Entering the patient in a registry, tracking progress there, and weekly caseload consultation with the consultant.
• Brief evidence-based interventions, such as behavioral activation or motivational interviewing.

The code belongs to the Behavioral Health Integration (BHI) family, which the AMA created and CMS began paying for in 2017. You bill 99492 once, for the month care starts. Every later month moves to 99493.

Three codes split the work across the episode

So which code fits which month? The answer turns on two questions: is this the first calendar month, and how many care manager minutes were logged?

These thresholds come from the CPT time rule, which lets a timed service be billed once its midpoint has passed. The APA collaborative care billing FAQ sets out the full ladder, and it notes that payer policies vary.

The minutes decide what you bill in month one

A common billing error is holding the claim until the month reaches 70 minutes, even though 36 was enough. The ladder below shows how the first month’s total maps to codes.

Worked example. A patient enrolls on March 14. The 99492 month still ends on March 31, because a calendar month runs first day to last. By then the care manager has logged 52 minutes, so you bill 99492 once.

On April 1, the patient moves to 99493, however few days March covered. Had March reached 90 minutes, you would add one unit of 99494.

One exception matters for safety-net sites. The APA notes that federally qualified health centers and rural health clinics do not use the CPT time rule, so check their separate CMS guidance.

Three roles run the program, but only one bills 99492

CoCM is a team service by definition. Each role has a fixed job, and mixing them up is a common audit finding.

• Treating physician or NPP (billing provider): Directs the care plan and bills 99492 under their own NPI. They don’t have to perform the care manager minutes personally.
• Behavioral health care manager: Someone with formal training in behavioral health, such as a social worker, nurse or psychologist. They deliver the counted minutes and maintain the registry, but they don’t bill 99492.
• Psychiatric consultant: A medical professional trained in psychiatry who can prescribe the full range of medications. They review the caseload and advise, usually without seeing the patient.

CMS doesn’t generally expect psychiatrists to bill the CoCM codes, because psychiatric work is already built into them. Submit under the directing clinician’s NPI, never the care manager’s or the consultant’s.

Only care manager time counts toward the threshold

The 99492 clock tracks the care manager’s minutes across the calendar month, face to face or not. These activities count:

• The initial behavioral health assessment
• Building and documenting the care plan
• Entering the patient in the registry and keeping it current
• Giving and scoring validated scales, such as the PHQ-9 or GAD-7
• Patient contacts in person, by phone or by video
• Caseload consultation with the psychiatric consultant
• Coordinating care with the rest of the treatment team

What does not count: the psychiatric consultant’s own time, and time spent on any separately billed service. A separately documented E/M visit can be billed in the same calendar month. Its time cannot also count toward the BHCM aggregate.

Six records keep a 99492 claim audit-ready

Thin documentation drives more 99492 denials than coding errors do. Keep each record below on file, because medical billing compliance expects it to be ready at any time.

Medicare pays about $160 for 99492 in 2026

Medicare pays CPT code 99492 under the Medicare Physician Fee Schedule. Based on the 2026 RVU data for 99492, the national non-facility rate is approximately $160 (2026, before locality adjustment). Rates reset every January 1, so confirm your locality in the CMS Physician Fee Schedule lookup before you bill.

Coverage outside traditional Medicare varies more:

• Medicare Part B: Covers 99492 with no federal prior authorization. Part B cost sharing applies, so the patient owes a copay.
• Medicaid: Coverage and rates differ by state. Some programs require separate enrollment, so check the state plan first.
• Commercial payers: Coverage is uneven. Horizon Blue Cross Blue Shield, for example, publishes a reimbursement policy for these codes.
• Prior authorization: Some commercial plans require it. Get it before the enrollment month starts, not after a denial.

Some codes can share the month with 99492, others can’t

Before you add a second code to the claim, check it against this table. Rules differ by code, and payers can add their own edits.

Chronic care management has its own page if you need the detail on 99490. Both programs need their own consent, and each minute can only count once.

Pick CoCM or general BHI before the month starts

CoCM codes (99492, 99493, 99494) and general BHI (99484) pay for two different care models. Picking the wrong one can be costly to correct, so decide at enrollment.

How a 99492 claim moves from enrollment to payment

Now for the claim itself. A clean claim for 99492 follows these steps in order.

1. Verify coverage. Confirm active Medicare Part B or commercial behavioral health benefits. Run insurance eligibility verification before enrollment.
2. Hold the initiating visit. New patients, and patients not seen within a year, need a qualifying visit with the billing practitioner first.
3. Record consent. Verbal consent is fine if it’s documented, and it covers consulting the psychiatric consultant.
4. Enroll the patient in the registry. Add a baseline PHQ-9 or GAD-7 score on day one.
5. Log care manager time as it happens. Note the date, duration and activity for every contact.
6. Get the consultant review on file. The psychiatric consultant reviews the case, and the advice goes in the record.
7. Choose the codes. Bill 99492 from 36 minutes, and add 99494 from 86 minutes.
8. Submit the claim. Once the time threshold is met, you can send it without waiting for month end.

Run this five-point check before you submit

A two-minute review catches most problems while you can still fix them. Before any 99492 claim leaves, confirm:

• The logged care manager minutes reach at least 36 for the month.
• The patient appears in the registry with a dated rating scale.
• A psychiatric consultant review note is in the record.
• Consent is documented, and so is the initiating visit where one was needed.
• This really is the patient’s first month, and the claim carries the directing clinician’s NPI.

Seven mistakes that get 99492 claims denied

Good denial management starts with prevention. These seven triggers cause most 99492 denials, and each has a fix.

• Undocumented time: The log lacks dates or activities. Have the care manager record time at the point of service.
• No consultant note: The caseload review is missing. Use a monthly sign-off note the consultant completes.
• No registry evidence: The record doesn’t show the patient was tracked. Update the registry daily, not as a month-end catch-up.
• Wrong month: 99492 billed in a month after the first. Check each patient’s month position on day 1 of the billing cycle.
• Missing consent: Add CoCM consent to the enrollment packet and record it before the first contact.
• No prior authorization: Check the payer’s policy during eligibility, not after the month closes.
• Wrong NPI: The claim went out under the care manager or consultant. Validate the billing NPI before batch submission.

If a claim still comes back, the denial codes in medical billing guide explains each reason code on the remittance.

How Pabau keeps 99492 documentation and claims together

Collaborative care teams often juggle three tools: a registry spreadsheet, a notes system and a billing portal. Each handoff between them is a chance for a minute, a note or a consent record to go missing.

Pabau, the practice management platform we build, keeps the clinical record and the claim in one place. Structured treatment notes and digital forms capture consent, rating scales and consultant reviews against the patient file. Our claims management software then pre-fills the claim from that record.

In the US, claims go out electronically through Claim.MD. Pabau checks the codes and required fields before submission, so incomplete claims don’t reach the payer.

Send cleaner collaborative care claims

Pabau keeps structured notes, consent forms and claims in one record. Claims for CPT 99492 go out through Claim.MD with code and required-field checks.

Book a demo

Conclusion

CPT code 99492 rewards teams that set up the month before it starts. Decide on CoCM over general BHI at enrollment, and get consent on file early. Then log every care manager minute as it happens.

Do that, and the 36-minute threshold stops being a month-end scramble. Skip it, and a missed note may require a corrected claim or appeal.

If your claims already run through a Claim.MD clearinghouse setup, keeping notes and claims together is the next step. Book a demo to see how Pabau handles collaborative care documentation and claims in one record.

Continue your research

Need to understand how clearinghouse submission works end to end? How medical claims clearinghouses work explains the electronic submission pathway from practice to payer.

Working through a denied 99492 claim? Denial codes in medical billing covers CARC reason codes and how to respond to common remittance denials.

Deciding between CCM and collaborative care? CPT code 99490 covers the time, consent and documentation rules for chronic care management.

Managing patients with more complex chronic needs? CPT code 99487 explains how complex chronic care management is billed.

Frequently asked questions