CPT 99493E&M

Sbsq psyc collab care mgmt

CPT 99493 covers follow-up psychiatric collaborative care management services after the initial month, involving ongoing coordination between a primary care team and psychiatric consultant for patients with behavioral health conditions.

Showing rates for

National Average

Base Medicare rate

$133.59

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

2.05

PE RVU (NF)

1.93

MP RVU

0.15

Total RVU

4.13

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

NCCI bundling edits

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Billing tips

Document exact time spent by behavioral health care manager each month; bill only when 60+ minutes accumulated
Impact: Billing with insufficient time (under 60 minutes) is the #1 audit trigger and can result in full recoupment of $133.59 plus penalties
Bill 99493 only once per calendar month, not per encounter; track cumulative time throughout the month
Impact: Multiple billings per month will be denied as duplicates; proper monthly billing ensures full $133.59 reimbursement
Ensure psychiatric consultant case review documented for each month billed; specific treatment recommendations required
Impact: Missing consultant documentation is second most common denial reason; can void entire claim worth $133.59
Use time-tracking tools to aggregate behavioral health care manager activities including care coordination calls, assessments, and psychiatric consult time
Impact: Accurate time tracking can increase monthly billing by 20-30% by capturing all billable activities that reach the 60-minute threshold
Verify patient has been previously billed with 99492 or 99484 before billing 99493; cannot bill 99493 as initial service
Impact: Billing 99493 without prior collaborative care initiation code results in automatic denial; must establish with 99492 first
Non-facility settings (clinics, offices) receive $34.61 higher reimbursement than facility settings ($133.59 vs $98.98)
Impact: Ensure correct place of service code to maximize reimbursement; POS 11 yields $34.61 more per service

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Frequently asked questions

What is the difference between CPT 99493 and 99492?

CPT 99492 is for the first month of psychiatric collaborative care management (70 minutes minimum), while 99493 is for each subsequent month (60 minutes minimum). You must bill 99492 first before using 99493 for ongoing months of collaborative care.

How much does Medicare pay for CPT 99493 in 2025?

Medicare pays $133.59 for 99493 in non-facility settings and $98.98 in facility settings based on the 2025 national average rates. Actual payment varies by geographic locality using the GPCI adjustment.

Can I bill 99493 more than once per month?

No, CPT 99493 can only be billed once per calendar month per patient. It represents all collaborative care management services provided during that entire month, regardless of how many patient contacts occur.

What counts toward the 60 minutes required for CPT 99493?

Qualifying time includes behavioral health care manager activities such as patient assessments, care coordination, communication with the psychiatric consultant, treatment plan development, collateral contacts, and data review. Only clinical staff time counts, not physician time alone.

Can CPT 99493 be billed with telehealth?

Yes, 99493 can be billed via telehealth using modifier 95. Patient contacts and care coordination can occur via phone, video, or in-person. The reimbursement rate remains the same whether delivered via telehealth or face-to-face.

How many months can I bill CPT 99493 for the same patient?

There is no limit to the number of months you can bill 99493 for a patient as long as they continue to need collaborative care management and meet the minimum 60-minute threshold each month. Many patients receive 6-12 months or longer of services.

Do I need a psychiatric consultant on staff to bill 99493?

You need access to a psychiatric consultant who regularly reviews cases, but they do not need to be employed by your practice. The consultant can be contracted, work via telehealth, or provide consultation remotely. They must review cases and provide treatment recommendations each billing month.