CPT 99484E&M

Care mgmt svc bhvl hlth cond

CPT 99484 covers care management services for patients with behavioral health conditions like depression or anxiety. This is for the initial month of coordinating care between visits, not the face-to-face appointment itself.

Showing rates for

National Average

Base Medicare rate

$53.05

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.93

PE RVU (NF)

0.66

MP RVU

0.05

Total RVU

1.64

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Track time meticulously using dedicated time logs. Only clinical staff time counts toward the 20-minute threshold, not physician time performing separately billable E/M services.
Impact: Prevents denials worth $53.05 per claim. Approximately 30% of practices fail to bill this code due to inadequate time tracking systems.
Bill 99484 only once per patient per lifetime for the initial month. Subsequent months require 99492 (less than 70 minutes), 99493 (70+ minutes), or 99494 (additional 30 minutes).
Impact: Incorrect use of 99484 in subsequent months results in automatic denials. Proper sequencing maintains ongoing monthly revenue stream averaging $40-85 per patient.
Ensure a billable E/M service (99201-99215, 99341-99350) occurs in the same month or within 30 days prior to initiating 99484 services to establish the treating relationship.
Impact: Missing the initiating visit results in 100% denial of the $53.05 claim. Many payers require documentation of this visit with claim submission.
Document patient consent specifically for behavioral health care management services, including data sharing, coordination activities, and regular contact by care team.
Impact: Lack of documented consent is a leading denial reason. Creates audit vulnerability that can trigger review of multiple months of claims.
Only one provider can bill care management codes (99484, 99487, 99489, etc.) per patient per month. Coordinate with other providers to avoid split claims and denials.
Impact: Duplicate billing results in denial of the second claim ($53.05 loss) and potential recoupment of previous payments if pattern identified.

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Frequently asked questions

What is the difference between CPT 99484 and 99492?

CPT 99484 is for the initial month of behavioral health care management services and requires at least 20 minutes of clinical staff time. CPT 99492 is for subsequent months when time is less than 70 minutes. You can only bill 99484 once per patient per lifetime; all following months use 99492, 99493, or 99494 depending on time spent.

How much does Medicare pay for CPT 99484 in 2025?

Medicare pays $53.05 for CPT 99484 in non-facility settings and $41.40 in facility settings based on the 2025 national average. Actual payment may vary by geographic location due to locality adjustments applied to the base rate.

Can I bill 99484 on the same day as an office visit?

Yes, but the time for the office visit (E/M service) does not count toward the 20-minute threshold for 99484. The 99484 code captures clinical staff time for care management activities throughout the calendar month, separate from face-to-face physician visit time. The office visit establishes the relationship and treatment plan that the care management supports.

What counts as clinical staff time for CPT 99484?

Clinical staff time includes care coordination, treatment planning, medication management support, symptom monitoring, patient education, communication with the treatment team, documentation in registries or care management platforms, and direct patient contact via phone, portal, or other non-face-to-face methods. Physician time spent on separately billable E/M services does not count. Only time by clinical staff under general supervision counts toward the threshold.

Do I need patient consent to bill 99484?

Yes, documented patient consent is required before billing CPT 99484. The consent should specify that the patient agrees to behavioral health care management services, understands care coordination activities will occur, agrees to regular contact by the care team, and consents to information sharing necessary for care coordination. Consent must be documented in the medical record and obtained before services begin.

Can I bill 99484 and chronic care management codes together?

No, you cannot bill 99484 and chronic care management codes (99490, 99439, 99487, 99489) for the same patient in the same calendar month. Only one care management service can be billed per patient per month. Choose the code that best represents the services provided and generates appropriate reimbursement based on the focus of care and time spent.

What diagnoses qualify for CPT 99484 billing?

CPT 99484 requires a behavioral health diagnosis, typically coded with ICD-10 F codes including depression (F32-F33), anxiety disorders (F40-F41), substance use disorders (F10-F19), ADHD (F90), PTSD (F43.1), bipolar disorder (F31), and other mental, behavioral, and neurodevelopmental disorders. The diagnosis must be documented and support the need for ongoing behavioral health care management.