Collaborative Care Codes

Policy No: 100
Originally Created: 11/01/2020
Section: Behavioral Health
Last Reviewed: 02/01/2024
Last Revised: 11/01/2024
Approved: 10/10/2024
Effective: 06/01/2024
Policy applies to: Group and Individual & Medicare Advantage.

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

Psychiatric collaborative care provides behavioral health service using Current Procedural Terminology (CPT®) codes 99492-99494 and Healthcare Common Procedure Coding System (HCPCS) code G2214.

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, Collaborative Care focuses on defined patient populations tracked in a registry, measurement-based practice and treatment to target. 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 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 or 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 are 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 the psychiatric collaborative care codes 99492 – 99494 and G2214 only when they have fully implemented and followed the Collaborative Care model. Our health plan will not reimburse when a psychiatrist chooses to interface directly with a patient.

Psychiatric Collaborative Care Services

Billing Medicare for Behavioral Health Integration (BHI) Services

None