Collaborative Care Model (CoCM) Billing Guide: CPT 99492, 99493 & 99494 Explained

Can a primary care practice treat mental health patients having depression and anxiety and get paid for these services? The Collaborative Care Model (CoCM) is the way primary care practices get paid for behavioral health services. The model was developed at the University of Washington's AIMS Center and proven in the IMPACT trial. Complexities and various billing scenarios are involved in the system of getting reimbursed for the CoCM model. This guide will discuss all the billing scenarios, denial reasons, and checklist to create a clean claim. Let's go deeper into what it is and who will get paid for which service.

What Is the Collaborative Care Model?

It is an evidence-based treatment of mental health conditions in primary care. Patients who want to get checked for mental health conditions like anxiety and depression from a primary care practice are billed under the CoCM model. This model is based on the monthly payments and codes that are time-based. Our experts know the billing intricacies of the CoCM model, its billing, and help primary care practices get paid. As the name of the model suggests, it is a team approach to treat mental health patients where primary care practice and psychiatrists work in collaboration to treat patients.

The CoCM Care Providers: Separate Roles and Billing Details

We need to understand who is responsible for what to completely understand the CoCM model and its related complexities. The team that provides care is based on three members.

The Practitioner Who Offers Care to Patient

The person who offers care to the patient is a practitioner in this model. Apart from the practitioner, physician assistant and nurse practitioner can also play a part in providing the care to mental health patients.

The behavioral health care manager (BHCM)

This is the person who is also a part of the team based on the CoCM model. A nurse can be this person, a counselor can be the behavioral health care manager, and a counselor can be the BHCM. The patient-related work is managed by this person, like assessments and making follow-up calls to patients.

The psychiatric consultant

This person does the analysis on the care provided by the team. A psychiatrist or psychiatric nurse fits in this role. The psychiatrist analyzes the work of the behavioral health care manager and advises what to do next. Is there anything needed to change in the treatment or not? One thing is important: the consultant is required to advise only, not seeing the patient directly.

Two Crucial Things in Creating CoCM Claims

While you are dealing with the CoCM claims, keep in mind that accurate claim submissions are key to optimal reimbursements. So, remember these two things:

The treating practitioner bills, not the psychiatric consultant

Remember that bundling works in this type of billing. The services are not billed one by one but a bundle of all the services are billed. The most important thing is to use the correct NPI (National Provider Identifier) number of the practitioner who treats the patient.

CoCM codes count the BHCM’s time (both face-to-face and non-face-to-face)

This is a unique feature where both types of minutes are billed for reimbursements. The face-to-face minutes and non-face-to-face minutes both. There are many crucial things in the care provided like caseload review, communication with the patient, registry work, everything is part of the CoCM code. Our mental health billing services help primary care practices get paid for services under the CoCM model.

The CoCM Codes and Their Time Thresholds

Here is each code with its official description and time threshold.

Important Note: If you find any billing guide that shows G0512 as the code used for FQHCs and rural health clinics, it is an older version created before 2026. This code was discontinued as of January 1, 2026, per CMS's updated billing guidance.

2026 Update: In the CY 2026 Physician Fee Schedule final rule, CMS also created three add-on codes — G0568 (based on 99492), G0569 (based on 99493), and G0570 (based on the general BHI code 99484) — for practices billing Advanced Primary Care Management (APCM) for the same patient in the same month. Unlike the CPT codes they are based on, these add-ons do not require tracking minutes. The CPT codes 99492, 99493, and 99494 remain the codes for CoCM billed outside the APCM pathway, so everything in this guide still applies. If you have seen claims that the CPT codes were "replaced" and old-code claims will be denied, that is a misreading of the CY 2026 final rule — the G-codes are an additional pathway, not a replacement.

The Midpoint Rule: What Becomes Billable in the CoCM Program?

This rule shows which time-based code becomes billable. For the time-based codes under the CoCM program, the mid-point rule determines whether the time-based code is ready to be billed or not. The time based-code becomes billable once the care manager spends more than half of the designated time slot. For instance, the care manager has to bill a 70-minute code, the time needed to be spent with the patient is 36 minutes. Why minute 36? Because half or middle of the 70 minute is 35, once an additional minute comes, it becomes 36 and becomes billable. For more clarity 35+1= 36, now reaching the minute 36 of the care manager makes it billable, as per the APA's CoCM billing guidance.

What each code implies:

One exception: The general BHI code CPT 99484 does not follow the rule of middle point. The 20 minutes of this code are 20 minutes.

What You Can and Can't Bill in the Same Month

Same-month combinations are the top denial driver in CoCM billing.

First Claim Submission Checklist

Here is the checklist to submit the first CoCM claim:

Common CoCM Denial Reasons (and How to Prevent Them)

Common reasons why the CoCM denials occur and how you can prevent revenue leakages

Frequently Asked Questions