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.
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.
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 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.
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.
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.
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:
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.
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.
Here is each code with its official description and time threshold.
| Code | Official Description | Listed time | Billable from | Notes |
|---|---|---|---|---|
| 99492 | Initial month of CoCM | First 70 min of BHCM time | Minute 36 | First calendar month only |
| 99493 | Subsequent months of CoCM | First 60 min of BHCM time | Minute 31 | Never in the same month as 99492 |
| 99494 | Add-on: each additional 30 min | +30 min per unit | Minute 16 of each unit | Never standalone, only with 99492 or 99493 |
| G2214 | The short month | First 30 min, initial or subsequent month | Minute 16 | For months that don't reach the 99492/99493 thresholds |
| 99484 | General BHI (the non-CoCM alternative) | 20 min of clinical staff time | 20 min (no midpoint rule) | No consultant, registry, or weekly review required |
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.
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.
The midpoint rule only pays practices that track every minute of care manager time. If nobody is tracking your care manager's minutes, you may be skipping months you could have billed.
Same-month combinations are the top denial driver in CoCM billing.
| Combination | Allowed? | Why |
|---|---|---|
| 99492 + 99493, same month | Never | A month is either initial or subsequent — never both |
| G2214 + any of 99492/99493/99494 | Never | G2214 is the short-month alternative, not a supplement |
| 99484 + CoCM codes, same patient & professional | Never | A patient is in general BHI or CoCM that month, not both |
| E/M visit + CoCM code, same month | Yes | Office visits are separately reportable — CoCM doesn't absorb them |
| Counting the same minutes toward two services | Never | Time billed under a separately reported service (like a therapy session the BHCM bills as CPT 90832) can’t also count toward the CoCM threshold |
| BHCM time during inpatient/observation stays | Excluded | CoCM minutes are outpatient minutes |
Here is the checklist to submit the first CoCM claim:
Common reasons why the CoCM denials occur and how you can prevent revenue leakages
Every denial on this list can be prevented with the right setup. And if some have already happened, that money is often still recoverable. Our mental health billing team fixes these exact problems.
Talk to a CoCM Billing ExpertWho can bill CPT 99492?
The practitioner who treats the patient can bill this code. This person can be a primary care provider, physician assistant, or nurse practitioner. The scope of this person includes E/M services.
How does psychiatry fit into the collaborative care model?
The psychiatrist advises about the treatment under the CoCM model. A psychiatrist’s time is billed in the monthly claim of the treating practitioner. It is a bundled service when it comes to billing. The treating role in the CoCM model belongs to the primary care provider. Primary care practices who need to structure the relationship with the psychiatrist coordinate it through their psychiatric billing workflows.
What's the difference between 99484 and the CoCM codes?
99894 is a general BHI code which is based on the 20 minutes of the clinical staff time. On the other hand, CoCM codes need a complete recording of the time slots based on the mid-point rule. A patient is billed under one model or the other in a given month, never both.
Can we bill an office visit in the same month as a CoCM code?
Yes. E/M visits can be separately billed while submitting a CoCM monthly code.It elaborates that it was not a part of the CoCM minutes
What replaced G0512 for FQHCs and RHCs?
As of January 1, 2026, FQHCs and RHCs bill the standard CoCM codes (99492, 99493, 99494) and G2214 directly.
You run the care model; we make sure every month of it gets paid.
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