CPT Code 99493 Billing Guide

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• 99493

CPT Code 99493 Billing Guide

CPT code 99493 for subsequent month psychiatric collaborative care management, 60 minutes. Billing guidance for behavioral health providers.

Quick Reference

Code

99493

Code System

CPT

Category

CPT Codes

Published

Feb 9, 2024

Updated

Mar 4, 2026

Reading Time

18 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

CPT Code 99493: Psychiatric Collaborative Care Management, Subsequent Month

Table of Contents:

• Introduction
• 99493 Overview
• Detailed Breakdown
• Impact on Healthcare System
• Billing Best Practices
• Compliance and Regulation
• Future Trends and Updates
• Conclusion

1. Introduction

According to data from the Substance Abuse and Mental Health Services Administration ( SAMHSA ), fewer than half of American adults with a diagnosed mental illness receive treatment in any given year. For those who do receive care, the majority are seen in primary care settings rather than specialty behavioral health clinics. This gap between need and access is precisely what the Psychiatric Collaborative Care Model (CoCM) was designed to address, and CPT code 99493 is the billing mechanism that sustains this model beyond the initial month of patient enrollment.

CPT code 99493 represents the subsequent month of psychiatric collaborative care management services, covering the first 60 minutes of clinical staff time per calendar month directed by a treating physician or other qualified healthcare professional. While CPT code 99492 captures the intensive startup phase of collaborative care — the first month when care plans are created, registries are established, and baseline assessments are administered — 99493 sustains the model month after month as patients progress through treatment.

The distinction between the initial and subsequent months matters because the collaborative care model is designed for ongoing, measurement-based management. Unlike episodic treatment approaches, CoCM relies on systematic monitoring using validated outcome measures, regular caseload review with a psychiatric consultant, and proactive treatment adjustments for patients who are not improving. Code 99493 recognizes that this sustained effort requires dedicated clinical staff time each month and provides the financial structure to support it.

For behavioral health organizations and primary care practices operating collaborative care programs, understanding the nuances of 99493 billing is essential. This code forms the backbone of CoCM revenue because most patients remain in collaborative care for multiple months. A typical CoCM patient may be enrolled for four to twelve months, meaning that 99493 will be billed far more frequently than the initial-month code 99492. Getting the documentation, time tracking, and team coordination right for 99493 is therefore critical to the financial sustainability of any CoCM program.

2. 99493 Overview

CPT code 99493 is defined by the American Medical Association as psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.

Purpose and Role in the CoCM Triad

CPT code 99493 is the middle component of a three-code framework that supports the Collaborative Care Model:

Together, these three codes provide comprehensive billing coverage for the entire CoCM workflow. Code 99492 covers the front-loaded work of enrolling patients and establishing treatment plans. Code 99493 sustains the model in every subsequent month. Code 99494 accounts for patients who require more intensive management in any given month.

Quick Facts about CPT Code 99493:

The significance of 99493 lies in its role as the recurring revenue code for collaborative care programs. While 99492 is billed once at the start of each CoCM episode, 99493 is billed every subsequent month that the patient remains in the program and the 60-minute time threshold is met. For programs managing panels of CoCM patients, 99493 billing volume directly determines the financial viability of the model.

• CPT 99492: Initial month, first 70 minutes of clinical staff time
• CPT 99493: Subsequent month, first 60 minutes of clinical staff time
• CPT 99494: Add-on for each additional 30 minutes in any month

• Covers subsequent months of CoCM (not the initial month)
• Requires at least 60 minutes of clinical staff time per calendar month
• Time is cumulative across the month, not per session
• Requires a three-member care team: treating provider, behavioral health care manager, and psychiatric consultant
• Must include registry-based tracking and measurement-based care
• Billed by the treating physician or other qualified healthcare professional, not the care manager
• Can be combined with 99494 for additional time beyond 60 minutes
• Patient must have been enrolled in CoCM during a prior month (typically billed under 99492)

3. Detailed Breakdown

To properly bill and document CPT code 99493, providers must understand the specific activities, team requirements, and clinical workflows that the code encompasses.

Components and Requirements

Clinical Staff Activities Counted Toward 99493 Time:

The 60-minute time threshold for 99493 includes the following behavioral health care manager activities:

Team Structure Requirements:

CPT 99493 requires the same three-member team as 99492:

• Systematic tracking and review: Updating the patient registry with current outcome scores, treatment status, and clinical notes. Reviewing the patient’s progress since the last contact using validated measurement tools such as the PHQ-9 for depression, GAD-7 for anxiety, or AUDIT-C for alcohol use.
• Patient contact and engagement: Direct communication with the patient via telephone, secure messaging, or in-person encounters to assess symptoms, review medication adherence, provide brief interventions, and coordinate care.
• Psychiatric consultant caseload review: Participating in systematic caseload review sessions with the psychiatric consultant, during which the consultant reviews registry data and provides treatment recommendations for patients who are not improving or who have complex presentations.
• Care plan revision: Modifying the treatment plan based on outcome measurement data, patient input, and psychiatric consultant recommendations. This may include adjusting medication management strategies, modifying therapy approaches, or updating referral plans.
• Care coordination: Communicating with the treating physician, other members of the patient’s care team, family members, and external providers to coordinate the behavioral health treatment plan with overall medical management.
• Documentation and registry management: Recording clinical activities, treatment decisions, and time logs in the medical record and the CoCM patient registry.

• Treating physician or qualified healthcare professional: Typically the primary care provider who directs the CoCM program, reviews consultant recommendations, and adjusts prescriptions. This is the provider who bills the 99493 code.
• Behavioral health care manager: A clinical staff member (licensed social worker, psychologist, psychiatric nurse, or counselor) who performs the day-to-day care management activities. This person’s time is what counts toward the 60-minute threshold.
• Psychiatric consultant: A psychiatrist or psychiatric nurse practitioner who regularly reviews the patient population in the registry, provides treatment recommendations, and may directly consult on complex cases.

Common Pitfalls

• Falling short of the 60-minute threshold: If the behavioral health care manager’s cumulative time for a patient does not reach 60 minutes in a given calendar month, 99493 cannot be billed. Unlike some care management codes, there is no partial-month billing option. Providers must either reach the threshold or not bill the code.
• Billing 99493 without an initial 99492: Code 99493 is designated for subsequent months. If the patient was never enrolled with an initial month of CoCM (99492), 99493 is not appropriate. Ensure the patient’s record shows a prior 99492 claim.
• Missing psychiatric consultant involvement: Every month that 99493 is billed, the record must demonstrate that the psychiatric consultant reviewed the patient’s case or was available and engaged with the CoCM caseload. If the consultant is unavailable for an extended period, the full CoCM model is not in place and 99493 should not be billed. Consider using CPT 99484 as an alternative when the full team is not operational.
• Counting non-qualifying time: Administrative tasks, general scheduling, and documentation time unrelated to clinical decision-making do not count toward the 60-minute threshold. Only clinical care management activities directed by the treating provider qualify.
• Failing to use measurement-based care: CoCM requires the regular use of validated rating scales to track patient progress. Months in which no outcome measures are administered or documented may not meet the requirements for 99493 billing.
• Neglecting the registry: The CoCM patient registry must be actively maintained and used for population-based caseload review. A registry that exists in name only but is not used to guide clinical decisions does not satisfy the 99493 requirements.

4. Impact on Healthcare System

The Collaborative Care Model, supported by the 99492/99493/99494 code triad, has had measurable effects across the healthcare system. Understanding these effects helps providers appreciate the clinical and financial value of sustaining CoCM programs month over month through 99493 billing.

Effects on Patients

• Sustained access to psychiatric expertise: Through 99493 billing, patients in primary care receive ongoing psychiatric consultation without needing to schedule appointments with a psychiatrist directly. The psychiatric consultant reviews their case as part of the CoCM caseload, and recommendations flow through the care manager and treating provider. This model addresses the severe shortage of psychiatrists in many regions.
• Measurement-based progress tracking: The monthly structure of 99493 ensures that validated outcome measures are administered regularly. Patients benefit from systematic tracking that identifies when treatment is not working, prompting timely adjustments rather than months of unchanged and ineffective therapy.
• Reduced treatment gaps: Because the care manager proactively contacts patients each month as part of 99493 activities, patients are less likely to fall through the cracks. Missed appointments, medication non-adherence, and worsening symptoms are detected early through ongoing monitoring.
• Lower stigma barrier: Receiving behavioral health care management through a primary care practice, rather than a specialty mental health clinic, reduces the perceived stigma that prevents many patients from seeking help.

Effects on Providers

• Predictable monthly revenue: For practices that have established CoCM programs, 99493 generates recurring monthly revenue for each enrolled patient. With a panel of 50 to 100 CoCM patients, 99493 billing can provide substantial and predictable income that supports care manager salaries and psychiatric consultant contracts.
• Improved clinical outcomes: Research consistently shows that CoCM improves outcomes for depression, anxiety, and substance use disorders compared to usual care. Providers participating in CoCM programs report higher satisfaction with their ability to address behavioral health needs.
• Operational complexity: Running a CoCM program requires infrastructure including registry software, time-tracking systems, psychiatric consultant agreements, and trained care managers. The ongoing nature of 99493 billing demands sustained operational investment.

Effects on Payers

• Long-term cost reduction: Multiple randomized controlled trials have demonstrated that CoCM reduces total healthcare expenditures by improving behavioral health outcomes, which in turn reduces emergency department visits, hospitalizations, and unnecessary medical utilization driven by untreated mental health conditions.
• Quality metric alignment: CoCM programs generate data that aligns with quality measurement programs such as HEDIS and MIPS. Payers benefit from improved quality scores across their covered populations.
• Upfront investment: Payers must support the monthly billing structure of 99493, which represents an ongoing cost. However, actuarial analyses have shown that these costs are more than offset by downstream medical savings for populations with significant behavioral health burden.

5. Billing Best Practices

Maximizing compliant reimbursement for CPT code 99493 requires systematic processes and attention to documentation detail.

Step-by-Step Billing Guide

• Verify ongoing CoCM enrollment: Confirm that the patient was enrolled in CoCM during a prior month (initial month billed under 99492) and that the patient has not been formally discharged from the program.
• Track clinical staff time throughout the month: Use a time-tracking system that captures each care manager activity with its date, duration, and description. Time must be tracked contemporaneously, not estimated retrospectively at month end.
• Administer validated outcome measures: At least once during the billing month, administer relevant rating scales (PHQ-9, GAD-7, AUDIT-C, or others) and document the scores in the registry and medical record.
• Conduct psychiatric consultant caseload review: Ensure the psychiatric consultant has reviewed the patient’s registry data and provided recommendations during the billing month. Document the review date, participants, and recommendations.
• Document care plan status: Record whether the existing care plan remains appropriate or requires modification based on the current month’s outcome data and consultant input.
• Verify the 60-minute threshold is met: Before submitting the claim, confirm that cumulative clinical staff time for the month equals or exceeds 60 minutes. If time falls between 60 and 89 minutes, bill 99493 alone. If time reaches 90 minutes, bill 99493 plus one unit of 99494.
• Submit the claim under the treating provider: The treating physician or qualified healthcare professional (typically the primary care provider) is the billing provider for 99493, not the care manager or psychiatric consultant.
• Apply appropriate diagnosis codes: Submit the claim with the ICD-10 codes for the behavioral health conditions being managed under CoCM.

Reimbursement Rates

As of March 2026, approximate reimbursement for CPT 99493:

• Medicare: National average payment of approximately $135 per month. Geographic adjustments apply based on the Medicare Physician Fee Schedule locality factors.
• Medicaid: Coverage varies by state. States with Medicaid CoCM coverage typically reimburse at rates ranging from $90 to $150 per month. Some states do not yet cover CoCM codes.
• Commercial payers: Rates typically range from $150 to $225 per month, though contracted rates vary widely. Many commercial payers now recognize CoCM codes, though some still require manual claims submission or prior authorization.

Tips for Maximizing Compliant Reimbursement

• Invest in time-tracking software: Manual time logs are error-prone and difficult to audit. Purpose-built CoCM software captures time automatically and generates reports that support claims.
• Establish a monthly billing rhythm: Set a specific date each month (e.g., the last business day) to review time logs, verify thresholds, and prepare claims for the entire CoCM panel.
• Monitor caseload size: A full-time behavioral health care manager can typically manage 50 to 80 active CoCM patients. Caseloads that exceed this range may compromise the quality of care and create audit risk if the 60-minute threshold is not genuinely met for each patient.
• Document why patients remain in CoCM: Payers may question ongoing 99493 billing for patients enrolled for many months. Document the clinical rationale for continued enrollment, including persistent symptoms, ongoing medication adjustments, or complex psychosocial needs.
• Coordinate with 99494 add-on billing: When clinical staff time exceeds 90 minutes in a month, bill 99493 plus 99494 for each additional 30-minute increment. This captures the full value of intensive management months without leaving revenue on the table.

6. Compliance and Regulation

Billing 99493 correctly requires adherence to federal and state healthcare regulations, as CoCM codes are subject to scrutiny from payers and government auditors.

Key Laws and Policies

• Health Insurance Portability and Accountability Act (HIPAA): CoCM involves sharing patient information among the care team (treating provider, care manager, psychiatric consultant). All communications must comply with HIPAA privacy and security requirements. Registry data containing protected health information must be stored and transmitted securely.
• False Claims Act (FCA): Submitting claims for 99493 when the CoCM model requirements are not met — such as billing without a psychiatric consultant or without reaching the 60-minute threshold — can constitute a false claim under federal and state false claims acts. Penalties include treble damages and per-claim fines.
• Anti-Kickback Statute (AKS): Financial arrangements between CoCM team members must be structured carefully. Compensation to psychiatric consultants or care managers should be based on fair market value for services rendered, not tied to billing volume or patient referrals.
• Stark Law (Physician Self-Referral Law): If the treating provider has a financial relationship with the entity providing care management services, the arrangement must fall within a Stark Law exception to avoid self-referral violations.
• State Medicaid Program Requirements: States that cover CoCM codes may impose additional requirements beyond federal rules, including specific provider credentialing, prior authorization, patient consent documentation, and reporting obligations.

Key Risks

• Audit exposure for time-based codes: Because 99493 requires a specific time threshold, auditors focus on whether time logs are accurate, contemporaneous, and supported by clinical documentation. Retroactive time estimates or round-number entries raise red flags.
• Team structure deficiencies: Billing 99493 without all three required team members in place is a compliance violation. If the psychiatric consultant contract lapses or the care manager position is vacant, 99493 cannot be billed during that period.
• Registry as documentation backbone: The CoCM registry is not optional — it is a defining feature of the model. A practice that bills 99493 without maintaining an active, population-based registry is at significant audit risk.
• Prolonged enrollment without clinical justification: Patients who achieve sustained remission (demonstrated by consistently low scores on validated measures) should be considered for discharge from CoCM. Continuing to bill 99493 for patients who no longer require collaborative care management may be viewed as medically unnecessary.

10-Point Compliance Checklist

• Verify that all three CoCM team members (treating provider, care manager, psychiatric consultant) are in place and actively participating each billing month.
• Confirm that the patient was enrolled in CoCM during a prior month with a documented initial-month service (99492).
• Track behavioral health care manager time contemporaneously using a structured time log or software system.
• Verify that cumulative clinical staff time meets or exceeds 60 minutes before submitting the claim.
• Document the administration and scoring of at least one validated outcome measure during the billing month.
• Record evidence of psychiatric consultant caseload review, including the date, participants, and treatment recommendations.
• Maintain an active CoCM patient registry with up-to-date clinical data for all enrolled patients.
• Document the clinical rationale for ongoing CoCM enrollment, especially for patients enrolled beyond six months.
• Store all CoCM records, including registry data, in a HIPAA-compliant system with appropriate access controls.
• Conduct quarterly internal audits of 99493 claims to verify documentation completeness and accuracy.

7. Future Trends and Updates

The Collaborative Care Model and its associated billing codes continue to evolve as evidence accumulates and payer policies mature.

• Expanded payer adoption: As of March 2026, an increasing number of commercial payers and state Medicaid programs have adopted CoCM codes. This trend is expected to continue as evidence of CoCM effectiveness in reducing total healthcare costs gains wider recognition. Providers who establish CoCM programs now are positioning themselves to capture expanding reimbursement opportunities.
• Technology-enabled CoCM delivery: Digital health platforms, patient-facing apps, and AI-assisted screening tools are being integrated into CoCM workflows. These technologies can improve efficiency in tracking outcomes, managing registries, and facilitating communication among team members, potentially allowing care managers to handle larger patient panels while maintaining quality.
• Telehealth permanence for CoCM activities: Many CoCM activities, including patient contacts and psychiatric consultant caseload reviews, can be conducted via telehealth. CMS has signaled ongoing support for telehealth delivery of care management services, and most payers now accept telehealth-based CoCM activities for 99493 billing.
• Integration with substance use disorder treatment: CoCM is expanding beyond its traditional focus on depression and anxiety to encompass substance use disorder management in primary care. This expansion aligns with the movement toward integrated treatment for co-occurring mental health and substance use conditions, creating additional clinical scenarios where 99493 billing is appropriate.
• Value-based payment models incorporating CoCM: Some payers are experimenting with alternative payment models that incorporate CoCM infrastructure costs into capitated or bundled payment arrangements. These models may eventually supplement or replace fee-for-service billing under 99493, though fee-for-service remains the dominant payment mechanism for CoCM as of 2026.

8. Conclusion

CPT code 99493 is the sustaining revenue mechanism for the Psychiatric Collaborative Care Model. While the initial month code 99492 launches the CoCM episode, 99493 keeps it running — month after month — as patients receive ongoing measurement-based care, regular psychiatric consultation, and proactive care management through their primary care provider’s practice.

Key takeaways from this guide:

For behavioral health organizations operating collaborative care programs, mastering 99493 billing is essential to program sustainability. The code represents the financial backbone of CoCM, and getting it right — from time tracking to documentation to compliance — determines whether a collaborative care program thrives or struggles.

• CPT 99493 covers subsequent months of CoCM with a 60-minute clinical staff time threshold per calendar month.
• The code requires the same three-member team structure as 99492: treating provider, behavioral health care manager, and psychiatric consultant.
• Registry-based tracking and validated outcome measures are mandatory components of the model.
• Medicare reimburses approximately $135 per month, with commercial rates typically ranging higher.
• Compliance depends on accurate time tracking, documented team involvement, and ongoing clinical justification for CoCM enrollment.

Additional Resources

• Insurance Billing Guides Hub — All HCPCS and CPT codes for behavioral health
• Understanding Behavioral Health Integration — Overview of BHI models and billing
• RCM Module — Automated claims and billing for behavioral health
• CMS Collaborative Care Model Fact Sheet ↗ — Official CMS guidance
• SAMHSA Behavioral Health Treatment Locator ↗ — National treatment resources

Related Billing Codes

• 99409
• 99484
• 99492
• 99494

Common questions

Official sources

• CMS Collaborative Care Model Fact Sheetcms.gov
• SAMHSA Behavioral Health Treatment Locatorfindtreatment.samhsa.gov