1st psyc collab care mgmt
CPT 99492 covers the first month of psychiatric collaborative care management, where a primary care team coordinates with a psychiatric consultant to treat patients with behavioral health conditions. This includes care management activities like regular monitoring, care plan adjustments, and consultant collaboration.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Track all care management time meticulously throughout the calendar month; bill only when 70+ minutes is reached
Impact: Billing without meeting 70-minute threshold results in 100% denial and potential audit flags
Document psychiatric consultant review and recommendations at least monthly; consultant must be available for consultation
Impact: Missing consultant documentation is the #1 denial reason, risking $145.24 per claim
Use validated assessment tools (PHQ-9, GAD-7) and document scores in medical record each month
Impact: Required for payment; absence can trigger recoupment of all payments during audit period
Bill only once per calendar month per patient; cannot bill 99492 and 99493/99494 in same month
Impact: Initial month uses 99492; subsequent months use 99493 or 99494 based on time
Obtain written patient consent for CoCM services and document in chart before first billing
Impact: Medicare requires documented consent; missing consent = denial of all claims for that patient
Do not bill 99492 with psychotherapy codes (90832-90838) or other care management codes (99490, 99491) for same patient same month
Impact: Bundling edits will deny the claim; choose the most appropriate care management model
Common denials
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