Claims guide

Collaborative Care Billing: Codes, Time Rules and Consent

Collaborative care billing is the monthly reporting of psychiatric collaborative care model (CoCM) services, where a billing practitioner, a behavioral health care manager and a psychiatric consultant work as one team. Medicare pays per calendar month, not per visit. This guide shows psychotherapists and psychiatrists which codes apply, how the minutes add up and what to document.

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What collaborative care billing covers

Collaborative care billing pays for team-based care that is mostly done between visits, so documentation matters more than usual.

Psychiatric collaborative care needs three roles: the treating practitioner, a behavioral health care manager and a psychiatric consultant. The care manager tracks the patient, the consultant advises on the plan, and the treating practitioner stays in charge. Because the work happens across a month, collaborative care billing is built on monthly time totals, and the team has to log minutes every day, not at month end. A daily log is what you hand a payer if they ask for proof.

The rules below come from the CMS Behavioral Health Integration Services booklet (MLN909432, January 2026 edition, checked 10/10/26). Medicare also pays for general behavioral health integration (BHI), which is a lighter version without the full three-role team.

What is collaborative care billing in plain terms?

Collaborative care billing means you report one set of monthly codes for a patient enrolled in CoCM. The first month uses 99492. Later months use 99493. An add-on, 99494, covers extra time. You may not report general BHI codes for the same patient in the same month as CoCM codes.

The 6 codes behind collaborative care billing

Time counts per calendar month, and the booklet also lists the practitioner time the code values assume.

Medicare BHI and CoCM codes (CMS MLN909432, checked 10/10/26)
Code	What it reports	Care team time per month	Assumed billing practitioner time
99492	Initial psychiatric CoCM month	First 70 minutes	30 minutes
99493	Subsequent psychiatric CoCM month	First 60 minutes	26 minutes
99494	Add-on to 99492 or 99493	Each additional 30 minutes	13 minutes
G2214	Initial or subsequent CoCM month	First 30 minutes	Usual work for the visit code
99484	General BHI (not CoCM)	At least 20 minutes of clinical staff time	15 minutes
G0323	General BHI care management by a clinical psychologist or clinical social worker	At least 20 minutes	15 minutes

Use G2214 when the month ends before you reach the minutes for 99492 or 99493. The booklet gives the example of a patient who is seen and then hospitalized or referred out of the practice. Use the CPT code guide to look up code definitions, and keep the list above next to your collaborative care billing worksheet.

A newer set of optional add-on codes, G0568, G0569 and G0570, starts January 1, 2026. They apply when BHI or CoCM is delivered in the same month as advanced primary care management and need a base code (G0556, G0557 or G0558). They are not time-based.

How to count minutes for collaborative care billing

The booklet says time counting follows CPT rules and payment is monthly. Some payers publish the minimum minutes needed to report each code. NC Medicaid, for example, lists 36 minutes for 99492, 31 for 99493 and 16 for G2214 or each 99494 unit. Do not assume your payer uses the same floor. Ask for the policy in writing, and build the minute log so it can support either reading of collaborative care billing time.

Read the reimbursement terms if you need a refresher on units, add-on codes and allowed amounts.

Collaborative care billing requirements

The code is only as good as the record behind it.

Initiating visit. Medicare requires one before BHI services. Qualifying visits are an annual wellness visit, an initial preventive physical exam, a comprehensive evaluation and management (E/M) visit or a transitional care management visit. For G0323, the psychiatric diagnostic evaluation (90791) is the initiating visit.
Eligible patient. A mental, behavioral or psychiatric condition, including substance use disorder. Medical comorbidity is not required.
Consent. The patient agrees before services start, including to consults with a psychiatric consultant. You must explain that cost sharing applies. Verbal consent is acceptable if you document it in the chart. Written consent is not required.
Care team. Staff must be employed or contracted by the billing practitioner and work under that practitioner's direction, within state law and scope of practice.
Episode end. A CoCM episode ends when treatment goals are met, when the patient is referred to direct psychiatric care, or after 6 consecutive months with no CoCM services.

Who is the billing practitioner?

The booklet says physicians of any specialty whose scope includes E/M can bill, as can physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives. That makes collaborative care billing a natural fit for a psychiatrist who leads the team. The booklet does not name psychotherapists as billing practitioners for CoCM, so a therapist usually works as the care manager inside someone else's CoCM, or bills G0323 for general BHI where their license and payer allow.

Check each payer's rules for who may serve as the care manager. Our practice management guides cover the revenue side of adding a new service line. See our who we serve page for the practice types MCM South works with, and the credentialing overview before you add a new team member to a payer.

Medicare, Medicaid and private rules for collaborative care billing

Do not carry one payer's rule into another's claim.

Medicare

Medicare pays the billing practitioner directly, with payment made per calendar month per patient. Everything in the tables above is Medicare policy. Two limits matter most: general BHI and CoCM cannot be reported for the same patient in the same month, and Medicare cost sharing applies to these services.

Medicaid

Coverage varies by state. As one example, NC Medicaid published a bulletin on December 30, 2025 applying to both Medicaid Direct and Managed Care. It lists 99492, 99493, 99494 and G2214, requires billing once a month by the treating physician or advanced practice provider, and end-dated G0512 on December 31, 2025 for federally qualified health centers and rural health clinics (NC Medicaid bulletin). Other states use different codes, rates and enrollment rules, so read your own state's manual.

Private payers

Commercial plans decide whether to cover CoCM, which codes to accept and whether a psychologist or social worker can be the care manager. The American Psychiatric Association notes that coverage differs between insurers, plans and state Medicaid agencies and should be confirmed payer by payer (APA best-practice document, dated 2020). Review the private insurance guides and your contracts before you start.

7 steps to start collaborative care billing

Work through these before the first monthly claim.

Pick the payer mix. Decide which payers you will bill for CoCM and confirm each pays it.
Name the team. Identify the billing practitioner, the care manager and the psychiatric consultant, and write down who employs or contracts each.
Schedule the initiating visit. Make sure the qualifying visit happens and is documented before BHI time starts.
Get and record consent. Note the patient's agreement, the consultant consults and the cost-sharing explanation in the chart.
Track minutes daily. Log care manager and consultant minutes by patient so month-end totals are exact.
Pick the code at month end. Match the total to 99492, 99493, 99494 or G2214 for that calendar month. Do not mix with 99484 in the same month.
Review the remittance. Check payments and denials on the electronic remittance advice and appeal wrong denials. The claim denial terms explain the common reason codes.

What to do Monday morning

Four jobs to make your collaborative care billing safer this week.

List every patient currently in CoCM or BHI and mark which code type you used last month.
Check that each patient has a documented initiating visit and consent in the chart. Missing paperwork undercuts the whole month of collaborative care billing.
Compare logged minutes with the codes you billed and fix any month where the total did not support the code.
Look up each payer's CoCM policy and your professional claim setup in the CMS-1500 guide, and then read the claim denials and appeals guide before the next denial arrives.

Frequently asked questions

What codes are used for collaborative care billing in Medicare?

Medicare uses 99492 for the first CoCM month, 99493 for later months and 99494 as an add-on for extra time. G2214 covers the first 30 minutes when a month falls short. General BHI uses 99484 or G0323 and cannot be reported in the same month as CoCM.

Does collaborative care billing need written patient consent?

Medicare does not require written consent. Verbal consent is acceptable if you document it in the medical record. The patient must agree before services start, including to consults with a psychiatric consultant, and you must explain that cost sharing applies. A new consent is needed only if the billing practitioner changes.

Can a therapist be the billing practitioner for CoCM?

The CMS booklet lists physicians and certain nurse practitioners and other non-physician practitioners as billing practitioners. It does not list psychotherapists. Therapists commonly serve as the care manager under the billing practitioner, or bill G0323 for general BHI where permitted. Verify each payer's rules.

How long does a CoCM episode of care last?

For collaborative care billing, Medicare ends a CoCM episode when treatment goals are met, when the patient is referred to direct psychiatric care or after 6 consecutive months with no CoCM services. A new episode can start later. NC Medicaid uses a similar six-month rule.

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