Collaborative Care Codes

Policy No: 100
Originally Created: 11/01/2020
Section: Behavioral Health
Last Reviewed: 02/13/2025
Last Revised: 02/01/2025
Approved: 02/13/2025
Effective: 03/01/2025
Policy applies to: Group and Individual & Medicare Advantage.

The policy applies to all physicians, other health care professionals, hospitals, and other facilities.

Collaborative Care Model (CoCM) – is a specific type of integrated care that treats common mental health conditions such as depression and anxiety that require systematic follow-up due to their persistent nature. Based on principles of effective chronic illness care, CoCM focuses on defined patient-centered team care, population-based care, measurement-based treatment to target, evidence-based care and accountable care. Trained primary care/specialty licensed medical providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who are not improving as expected.

CPT code 99492 – Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of Behavioral Health/Collaborative Management (BHCM) activities, in consultation with a psychiatric consultant, and directed by the treating physician or other Qualified Health Professional (QHP), with the following required elements:

• outreach to and engagement in treatment of a patient directed by the treating physician or other QHP;
• initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan;
• review by the psychiatric consultant with modifications of the plan if recommended;
• entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and

• provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies.

CPT code 99493 - Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP, with the following required elements:

• tracking patient follow-up and progress using the registry, with appropriate documentation;
• participation in weekly caseload consultation with the psychiatric consultant;
• ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other QHP and any other treating mental health providers;
• additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant;
• provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies;
• monitoring of patient outcomes using validated rating scales; and

• relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.

CPT code 99494 - Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP (List separately in addition to code for primary procedure) (Use 99494 in conjunction with 99492, 99493).

HCPCS code G0323 - Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month, with the following required elements:

• initial assessment or follow-up monitoring, including the use of applicable validated rating scales;
• behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes;
• facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by Medicare to prescribe medications and furnish E/M services, counseling and/or psychiatric consultation; and

• continuity of care with a designated member of the care team

HCPCS code G2214 - Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP.

Psychiatric Consultant – A board certified psychiatrist, board certified psychiatric mental health practitioner or board certified psychiatric advanced registered nurse practitioner. These providers must also be able to practice independently by their state licensing boards.

Primary care and appropriate Licensed Medical Practitioners – Physicians (Medical Doctor (MD), Doctor of Osteopathic (DO), Naturopathic Doctor (ND), Non-Physician Practitioner (NPP), Physician Assistant/Physician Associate (PA) and Nurse Practitioner (NP). These are typically primary care but may be of another specialty such as cardiology or oncology.

Our health plan follows Centers for Medicare & Medicaid Services (CMS) guidelines for psychiatric collaborative care services. Our health plan will reimburse appropriate licensed medical practitioners for the psychiatric collaborative care codes 99492 – 99494, G0323 and G2214 only when they have fully implemented and followed the Collaborative Care model. Our health plan will not reimburse CoCM codes when a psychiatric provider chooses to interface directly with a patient.

Billing Medicare for Behavioral Health Integration (BHI) Services – Frequently Asked Questions

Behavioral Health Integration Services

About Collaborative Care

Learn about Collaborative Care Model

Collaborative Care Flow Chart

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