1st/sbsq psyc collab care
CPT 99494 is billed for the first month of psychiatric collaborative care management, where a primary care team coordinates behavioral health treatment with a psychiatric consultant. This involves regular monitoring and treatment adjustments for patients with mental health conditions being treated in a primary care setting.
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 clinical staff time meticulously throughout the calendar month using time logs; you need 70 minutes of documented care management time to bill 99494 in the initial month
Impact: Inadequate time documentation is the #1 cause of denials, resulting in loss of $55.96 per patient per month
Bill 99494 only once per patient per calendar month for the FIRST month of treatment; subsequent months require 99484 (initial) or 99492 (continuation) depending on time thresholds
Impact: Billing 99494 in subsequent months triggers automatic denials; proper sequencing maintains continuous revenue stream
Ensure psychiatric consultant time is separately documented (minimum 30 minutes per month) and that consultation occurs before billing; consultant reviews must be interactive, not just chart review
Impact: Missing psychiatric consultant documentation leads to 30-40% denial rate in audits
Use validated clinical rating scales (PHQ-9, GAD-7, etc.) and document baseline and follow-up scores in the medical record; this is a required element, not optional
Impact: Absence of systematic outcome measurement is grounds for recoupment in audits; scales must be documented at enrollment and monthly
Document patient consent for CoCM services specifically, including explanation of the team-based approach and data sharing with psychiatric consultant
Impact: Missing consent documentation can void the entire episode of care billing, potentially $200+ in recoupments per patient
Do not bill 99494 with E&M codes on the same date of service by the same provider; CoCM is non-face-to-face care coordination, not direct physician time
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