1st/sbsq psyc collab care
CPT 99494 covers the first 70 minutes of psychiatric collaborative care management in a month, where a primary care team works with a psychiatric consultant to manage behavioral health conditions alongside physical care.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Track and document all time in calendar month, including behavioral health care manager activities, care coordination, and psychiatric consultant review time. Only the first 70 minutes are reported with 99494; additional time requires 99495.
Impact: Accurate time tracking ensures appropriate code selection and can increase revenue by $53.22 when time exceeds 100 minutes (adding 99495)
Bill 99494 only once per calendar month per patient. This is a monthly code, not per-visit. Cannot be billed with 99493 in the same month.
Impact: Prevents denials and recoupment; incorrect billing with both codes results in 100% denial of one service
Ensure psychiatric consultant review occurs within the billing month. Document the date and time of psychiatric consultation and treatment recommendations.
Impact: Missing psychiatric consultant documentation is a leading denial reason, resulting in loss of full $55.96 payment
Use a systematic registry or tracking system (required by CMS). Document use of validated rating scales for symptom tracking at initiation and follow-up.
Impact: Registry use is a billing requirement; absence can trigger audit and recoupment of all claims
Document patient consent for collaborative care at initiation. Include explanation of the model, team members, and information sharing.
Impact: Lack of consent documentation can result in denial and potential compliance issues
Bill under the treating physician or qualified healthcare professional who directs the patient's care, not the behavioral health care manager or psychiatric consultant.
Impact: Billing under incorrect provider NPI results in denial and claim resubmission delays
Common denials
Insufficient time documented - less than 70 minutes of qualifying activities in the calendar month
How to appeal: Submit detailed time log showing all behavioral health care manager activities, care coordination, and psychiatric consultation time totaling 70+ minutes. Include dates, duration, and description of each activity. If time was 36-69 minutes, rebill as 99493.
Missing psychiatric consultant review documentation or review occurred outside the billing month
How to appeal: Provide psychiatric consultant's signed notes showing date of case review, recommendations, and treatment adjustments within the calendar month billed. Include consultant's credentials and NPI.
No documented use of systematic tracking registry or validated rating scales
How to appeal: Submit evidence of registry use showing patient enrollment, symptom tracking with validated scales (PHQ-9, GAD-7, etc.), and systematic follow-up. Provide screenshots or registry reports demonstrating compliance.
Billed with 99493 in same month or overlapping with other care management services (CCM, TCM, BHI codes)
How to appeal: Review billing records to confirm no overlap. If services were distinct and non-overlapping time periods, provide documentation showing separate services. Otherwise, withdraw duplicate claim and ensure correct code selection going forward.
Frequently asked questions
What is the Medicare reimbursement rate for CPT 99494 in 2025?
The 2025 Medicare national average reimbursement for CPT 99494 is $55.96 for non-facility settings and $38.82 for facility settings. Actual payment may vary based on geographic locality adjustments.
How many times can CPT 99494 be billed per month?
CPT 99494 can only be billed once per patient per calendar month. It represents the first 70 minutes of psychiatric collaborative care management services in that month. For additional time beyond 70 minutes in the same month, use add-on code 99495.
What is the difference between CPT 99493 and 99494?
CPT 99493 requires at least 36 minutes of collaborative care services in the initial month only, while 99494 requires at least 70 minutes and can be used for either initial or subsequent months. You cannot bill both codes in the same calendar month for the same patient.
Who can bill CPT 99494?
The treating physician or qualified healthcare professional (e.g., primary care provider) bills 99494. Services are delivered by a behavioral health care manager under the direction of a psychiatric consultant, but the billing provider is the primary care physician managing the patient's overall care.
What time counts toward the 70 minutes required for CPT 99494?
Qualifying time includes behavioral health care manager activities such as patient assessment, care coordination, treatment planning, communication with the patient and family, psychiatric consultant review time, documentation in the registry, and care management. It does not include time for separately billable E&M visits or psychotherapy.
Can CPT 99494 be billed with chronic care management codes?
No, CPT 99494 cannot be billed in the same month with chronic care management (99490, 99439, 99487, 99489), transitional care management, or behavioral health integration codes (99484, 99492-99493) as these represent overlapping time and services.
Is a psychiatric consultant required for billing CPT 99494?
Yes, psychiatric consultant involvement is mandatory. A psychiatrist (MD/DO) or psychiatric nurse practitioner must regularly review cases and provide treatment recommendations. The psychiatric consultant's review must occur within the billing month and be documented in the medical record.