What does Psychiatric Collaborative Care pay in 2026?
| Code | What it covers | CY2026 national non-facility |
|---|---|---|
| 99492 | initial month, 70 min | $160.32 |
| 99493 | subsequent months, 60 min | $144.96 |
| 99494 | each added 30 min, max 4 units | $61.46 |
| G2214 | brief month, 30+ min | $60.79 |
National averages from our verified CY2026 fee-schedule config (source: CMS Physician Fee Schedule). Actual payment varies by locality, payer, and site of service.
Who can bill it?
The treating practitioner — a physician or NP/PA/CNS — bills the codes. The behavioral care manager's time is what accumulates toward the thresholds.
The behavioral care manager furnishes the tracked minutes; the psychiatric consultant reviews the caseload weekly and must actually be recorded on the enrollment — a CoCM claim without a named psychiatric consultant isn't a CoCM claim.
One treating practitioner bills CoCM per patient-month, and that same practitioner can't also bill general BHI for the same patient that month.
What are the minute thresholds?
- The FIRST month a patient is ever billed needs 70 minutes of behavioral care-manager time (99492).
- Every later month needs 60 minutes (99493).
- Each added 30 minutes bills a 99494 unit, capped at 4 units (CMS MUE).
- A month that reaches 30 minutes but misses the full threshold bills the brief code G2214 instead — G2214 and the full codes are mutually exclusive in a month.
- Which threshold applies is decided by the patient's real billing history — a 60-minute month for a patient never billed before is a G2214 month, not a 99493 month.
What has to be in place first?
- A recorded psychiatric consultant
- CMS requires a medical professional trained in psychiatry, qualified to prescribe the full range of medications, in the consulting role — recorded on the enrollment, not implied.
- Registry + weekly caseload review
- The care manager tracks the caseload in a registry the psychiatric consultant reviews weekly. This is the model's spine, and it's a billing requirement.
- Monthly measurement-based care
- A validated rating scale score captured every billed month — same instrument class as BHI.
- Consent and enrollment
- Documented consent with the single-biller disclosure, and program enrollment, before the first claim.
What gets claims denied?
- Calling a first month 'subsequent'
- The 70-minute initial threshold applies to the patient's first-ever billed CoCM month. Sixty minutes in a true first month is a G2214 month — billing 99493 overstates it.
- No psychiatric consultant on record
- Real care-manager minutes without a recorded psychiatric consultant don't make a CoCM claim — the consultant is a structural element, not a formality.
- G2214 alongside the full codes
- A month bills the brief code OR the full threshold codes, never both.
- Same practitioner billing BHI too
- CoCM's codes include the BHI work — the same practitioner billing both for one patient-month double-counts and the BHI line is suppressed.
- Confusing the APCM G-codes
- G0568/G0569 are the APCM-attached versions of the CoCM months; they bill only with an APCM bundle. Standalone CoCM stays on 99492/99493/99494.
What could this look like for your panel?
Estimates only, not billing advice. Actual Medicare reimbursement varies by region, payer, and year. Figures approximate CY2026 national non-facility averages from our verified fee-schedule config.
Frequently asked questions
- What team does CoCM actually require?
- Three roles: the treating (billing) practitioner, a behavioral care manager whose tracked time drives the thresholds, and a psychiatric consultant who reviews the registry caseload weekly and can recommend the full range of medications.
- When does 99492 vs 99493 apply?
- 99492 (70 minutes) covers the patient's first-ever billed CoCM month; 99493 (60 minutes) covers every month after. The distinction follows real billing history, not the calendar.
- What is G2214 for?
- A brief CoCM month: at least 30 minutes of care-manager time that doesn't reach the full threshold. It pays about $60.79 and is mutually exclusive with the full codes in that month.
- Can CoCM and CCM be billed in the same month?
- Yes — CoCM manages the behavioral condition, CCM the chronic-condition list. Minutes are counted once, toward one family only.
This page is general information, not billing, coding, or legal advice. Verify current requirements with the relevant payer before billing. Mallowa helps practices capture and document coordination time and generates claim-ready superbills; it does not submit claims or determine eligibility.