Reimbursement for Collaborative Care

The CPT codes (99492, 99493, and 99494) are codes that can only be billed by primary care physicians (or non-physician practitioners) in primary care settings.  The codes and the documentation required specifically support CoCM and its use of a practice-based behavioral health care manager (BHCM) and a consulting psychiatrist to a help manage a population of patients with a psychiatric disorder in the primary care practice.  In North Carolina, more than 150 physicians have been trained by the APA, which has a grant to serve as a Support and Alignment Network (SAN) through the CMS Transforming Clinical Practice Initiative (TCPi). 

The NC Psychiatric Association will help interested practices find psychiatric consultants who are trained in the CoCM. Click here to find a psychiatric consultant.

By using the collaborative care CPT codes, primary care practices now have the billing codes to put in place one of the most researched, evidence-based models for integrating behavioral health into the medical home.  Until now, this model has been funded primarily through grants or as part of the overhead for progressive practices that saw its value. 

Opportunities to Implement the Collaborative Care (CPT) Codes

Primary care practices that are providing collaborative care services can now bill for those services using CPT® codes for Psychiatric collaborative care management services (99492, 99493, 99494). Medicare, BCBSNC, and NC Medicaid plans are also providing coverage.

NC AHEC is providing education and practice-based support to primary care practices interested in implementing CoCM, including coaching on workflows and billing/coding, registry implementation, and continuing education. Learn more

CCNC is providing access to an enhanced version of the AIMS Caseload Tracker Registry for up to three years for qualifying practices starting in the fall of 2022.