| Executive Summary Behavioral health case management requires precise CPT coding to ensure proper reimbursement and compliance. With codes like 99484, 99492, 99493, 99494, G2214, and G0323, each service has specific time requirements, documentation rules, and billing conditions. Mistakes can lead to denials, lost revenue, and audit risk. This guide explains every key CPT and HCPCS code, including team conference codes, common errors to avoid, and CMS documentation requirements, helping providers and care managers submit clean claims and get paid accurately. Key Takeaways: ● 99484 covers general behavioral health integration (≥20 minutes/month, non-face-to-face). ● 99492/99493/99494 are for Collaborative Care Model (CoCM) initial, subsequent, and add-on time. ● G2214 and G0323 allow flexibility for short encounters and services by psychologists/social workers. ● 99366–99368 track medical team conferences with or without patients. ● Accurate documentation is essential: time, provider direction, diagnosis, registry tracking, and care plan updates. ● Avoid common billing errors like overlapping codes, missing registry documentation, or using retired codes. ● Telehealth delivery is allowed but may require modifiers per payer rules. |
Understanding CPT code 99484 is key to billing case management services correctly. As the primary code for general Behavioral Health Integration (BHI) care management, it applies when clinical staff spend at least 20 minutes per calendar month coordinating a patient’s behavioral health care.
But 99484 is just the starting point. Behavioral health case management uses a specific set of CPT codes depending on the care model, the provider type, and the time spent. Getting these codes wrong leads to claim denials, compliance risk, and lost revenue.
This guide covers every CPT code used in behavioral health case management. You will find what each code covers, who can bill it, minimum time requirements, and what CMS requires for documentation.
Whether you are billing general BHI services under 99484 or managing a full Collaborative Care Model program, here you will find the exact rules to submit clean claims and get paid accurately.
What are the CPT Codes for Mental health care coordination?
Standardized billing codes are used to report care coordination, team conferences, and integrated behavioral health services to insurance payers, including Medicare and Medicaid. It covers:
- Coordinating care between behavioral health providers and primary care
- Monitoring patient progress using registries and structured assessments
- Developing and updating behavioral health care plans
- Medical team conferences involving interdisciplinary providers
- Collaborative care under psychiatric supervision
The American Medical Association maintains these codes. CMS determines Medicare reimbursement rates and coverage requirements for each.
The 6 Core CPT Codes for Case Management Behavioral Health
Understanding the key CPT codes is essential for effective case management. CPT 99484 serves as the cornerstone for general behavioral health integration, covering at least 20 minutes of care management per month.
It supports patients with mental health, psychiatric, behavioral, or substance use disorders, ensuring coordinated, non-face-to-face care under a qualified provider’s guidance.
Here’s a breakdown of the six core CPT codes that drive effective behavioral health case management, including their definitions, time requirements, and clinical applications.
CPT 99484 – General Behavioral Health Integration (BHI)
CPT 99484 covers at least 20 minutes of clinical staff time per calendar month for care management services related to behavioral health conditions, directed by a physician or qualified health care professional.
This is the foundational code for general behavioral health integration. It applies broadly to:
- Mental health conditions
- Psychiatric conditions
- Behavioral health disorders
- Substance use disorders are being treated by the billing provider
Key requirements for billing 99484 are:
- Minimum 20 minutes of clinical staff time in the calendar month
- Services directed by a physician or QHP
- Patient must have at least one diagnosed behavioral health condition
- An ongoing relationship between the patient and the billing provider must exist
- Services are typically non-face-to-face (care management, not therapy)
Because 99484 can be provided under general supervision, clinical staff, including care managers, nurses, and social workers (under provider direction), can deliver these services.
99484 clinically covers:
- Patient assessment and care planning
- Behavioral health plan development or revision
- Facilitation of treatment adherence
- Coordination with other providers
- Referral management for behavioral health services
Billing 99484: Bill once per patient per calendar month, regardless of total time spent beyond 20 minutes. It cannot be billed in the same month as 99492 or 99493 for the same patient.
CPT 99492 – Initial Psychiatric Collaborative Care Management
CPT 99492 covers the first 70 minutes of Collaborative Care Model (CoCM) services in the first calendar month of psychiatric integration.
This code launches the Psychiatric Collaborative Care Management (CoCM) model. CoCM is a structured care model developed at the University of Washington that requires 3 team members:
- The billing physician or QHP (typically a primary care provider)
- A behavioral health care manager (with specialized behavioral health training)
- A psychiatric consultant
Time requirement: 70 minutes in the first calendar month.
CPT 99492 is billed only once per patient, during the initial month of CoCM services. After that, use 99493 for subsequent months.
Required elements for 99492 are:
- The behavioral health care manager performs an initial assessment
- Registry tracking begins
- The care plan is developed
- A psychiatric consultant is engaged
- Patient education and treatment monitoring begin
CPT 99493 – Subsequent Psychiatric Collaborative Care Management
CPT 99493 covers the first 60 minutes of CoCM behavioral health care manager activities in each subsequent month after the initial month.
This is the ongoing monthly billing code for patients in the CoCM program. It covers:
- Patient follow-up and progress monitoring via registry
- Participation in weekly caseload consultation with the psychiatric consultant
- Ongoing care plan updates
- Coordination and communication with the treating provider
Billing 99493: Bill once per patient per calendar month beginning in month 2 of CoCM services. Use 99494 as an add-on for additional time.
CPT 99494 – Add-On Time for Psychiatric Collaborative Care
CPT 99494 covers each additional 30 minutes of CoCM activities in a calendar month, billed in conjunction with 99492 or 99493.
Use 99494 when:
- Month 1 CoCM time exceeds 70 minutes (add to 99492)
- Subsequent month, CoCM time exceeds 60 minutes (add to 99493)
Maximum add-on units: Up to 4 units of 99494 per month (Medicaid Utilization Equivalent limit). The University of Washington AIMS Center, which developed the CoCM model, confirms this limit.
HCPCS G2214 – First 30 Minutes of Psychiatric CoCM
G2214 covers the first 30 minutes of psychiatric CoCM behavioral health care manager activities in a month, billed in conjunction with 99492 and 99493.
CMS added this code to capture shorter encounter periods within the CoCM model. It applies when a patient may be referred elsewhere or hospitalized, making the full 70-minute (99492) or 60-minute (99493) thresholds unachievable in that month.
HCPCS G0323 – BHI Billing for Clinical Psychologists and Social Workers
G0323 covers at least 20 minutes per calendar month of behavioral health care management services provided by a licensed clinical psychologist or clinical social worker.
Effective 2023, CMS created G0323 to expand billing access for clinical psychologists (CPs) and clinical social workers (CSWs) who provide BHI services independently. It mirrors 99484 but is specific to these provider types.
CPT Codes for Behavioral Health Team Conferences (Case Management)
When multiple providers from different disciplines meet to coordinate a patient’s behavioral health care, team conference codes apply.
CPT 99366 – Medical Team Conference with Patient/Family Present
CPT 99366 covers a medical team conference of 30 minutes or more with the patient and/or family present, with participation by a nonphysician qualified health care professional.
Requirements:
- Minimum 3 qualified health care professionals from different specialties or disciplines
- All must provide direct care to the patient
- All must have performed face-to-face evaluations within the previous 60 days
- All must be present for the entire conference
- No more than one individual from the same specialty may report this code at the same encounter
CPT 99367 – Physician Participation in Medical Team Conference (No Patient)
CPT 99367 covers a medical team conference of 30 minutes or more without patient/family present, with physician participation.
CPT 99368 – Nonphysician Participation in Medical Team Conference (No Patient)
CPT 99368 covers a medical team conference of 30 minutes or more without patient/family present, with nonphysician QHP participation.
This code applies frequently in behavioral health case management, for example, when a social worker participates in a care coordination meeting for a patient with complex mental health needs, without the patient being present.
Billing rule for 99366–99368: Do not report these codes for conferences under 30 minutes total. Time does not include documentation; only the active conference period counts.
Table: CPT Code – Behavioral Health Case Management
| CPT/HCPCS Code | Description | Minimum Time | Billing Frequency |
| 99484 | General BHI care management | 20 min/month (clinical staff) | Once/month/patient |
| 99492 | Initial CoCM (first month) | 70 min (first month) | Once per patient |
| 99493 | Subsequent CoCM | 60 min/month | Once/month from month 2 |
| 99494 | Add-on: additional CoCM time | 30 min blocks | Up to 4/month |
| G2214 | CoCM first 30 min (short encounter) | 30 min | Add-on to 99492/99493 |
| G0323 | BHI by CP/CSW | 20 min/month | Once/month/patient |
| 99366 | Team conference, patient present (non-MD) | 30 min | Per encounter |
| 99367 | Team conference, patient absent (physician) | 30 min | Per encounter |
| 99368 | Team conference, patient absent (non-MD) | 30 min | Per encounter |
Additional Behavioral Health CPT Codes Used in Case Management Settings
Beyond core BHI and CoCM codes, behavioral health case management encounters these CPT codes regularly:
Preventive and Screening Codes are:
- 99401–99404: Preventive medicine individual counseling (15–60+ min)
- 99406/99407: Smoking and tobacco cessation counseling
- 99408/99409: Alcohol and substance abuse screening and brief intervention
Assessment and Diagnostic Codes are:
- 90791: Psychiatric diagnostic evaluation (initial)
- 90792: Psychiatric diagnostic evaluation with medical services
- 96130: Psychological testing, emotional, behavioral, and cognitive assessments
- 99483: Cognitive assessment and care plan services
Psychotherapy Codes (individual therapy in case management context) are:
- 90832: Psychotherapy, 30 minutes
- 90834: Psychotherapy, 45 minutes
- 90837: Psychotherapy, 60 minutes
- 90847: Family therapy with the patient present
HCPCS Codes for Community-Based Behavioral Health are:
- H2011: Crisis intervention services, per 15 minutes
- H2014: Skills training and development, per 15 minutes
Key Documentation Requirements
Accurate documentation is the single most important factor in getting these claims paid. CMS requires specific elements for each code.
For CPT 99484 (General BHI):
- Behavioral health diagnosis (ICD-10)
- Clinical staff time documented (at least 20 minutes)
- Evidence of care management activities performed
- Provider direction documented in the record
- Date of service
For CPT 99492/99493 (CoCM):
- Registry tracking evidence
- Psychiatric consultant involvement documented
- Behavioral health care manager’s qualifications on file
- Patient consent
- Time documentation for all care manager activities
- Weekly caseload consultation records
For CPT 99366–99368 (Team Conferences):
- Names and specialties of all participating professionals
- Start and end time of the conference
- Summary of clinical issues discussed
- Treatment recommendations made
- Documentation that all participants had seen the patient in the prior 60 days
Common denial reasons are:
- No documented diagnosis linked to billed services
- Time not documented precisely
- Billing 99484 and 99492 in the same month for the same patient
- G0511 billing errors (this code retired on July 1, 2025; RHCs/FQHCs must switch to 99484)
- Missing psychiatric consultant documentation for CoCM codes
Who Can Bill CPT Codes For Case Management Behavioral Health?
It depends on the care model, the provider type, and the service being delivered. Using the right code under the wrong provider type is one of the most consistent reasons these claims get denied.
For general BHI services under 99484, any physician or non-physician practitioner whose scope includes evaluation and management services can bill.
For CoCM codes, the billing provider is the physician or QHP leading the care team.
Notably, the American Psychiatric Association clarifies that psychiatrists are generally not expected to bill CoCM codes, since psychiatric consultation is a component of the model rather than the billing role.
The table below outlines billing eligibility by code group:
| Code | Who Can Bill |
| 99484 | Primary care physicians, psychiatrists, nurse practitioners, physician assistants, and clinical nurse specialists |
| 99492, 99493, 99494 | The billing physician or QHP leading the CoCM care team |
| G0323 | Licensed clinical psychologists and clinical social workers only |
| 99366, 99367, 99368 | Any participating QHP from a different specialty or discipline than the others in the conference |
Common Care Coordination Billing Mistakes and How to Avoid Them
Even experienced billing teams can make costly mistakes when coding behavioral health case management. Small errors in code selection, documentation, or time tracking can trigger denials, reduce reimbursement, and create compliance risks. Knowing what to watch for helps your practice submit clean claims and maximize revenue.
Here are the top mistakes you should avoid:
- Using 99484 for Therapy Instead of Care Management
- Mistake: Billing 99484 for psychotherapy sessions.
- Fix: Reserve 99484 strictly for non-face-to-face care management. Use 90832–90837 for therapy.
- Not Documenting Provider Direction for 99484
- Mistake: Clinical staff perform BHI services without documenting physician or QHP supervision.
- Fix: Include explicit notes showing the provider directed or supervised care management.
- Billing 99492 Multiple Times for the Same Patient
- Mistake: Charging 99492 more than once in the initial CoCM month.
- Fix: Bill 99492 only for the first month; use 99493 for subsequent months, and 99494 for add-on time.
- Missing Registry Documentation for CoCM Codes (99492/99493/99494)
- Mistake: Failing to track patient progress in the registry.
- Fix: Maintain complete registry records showing assessments, care plan updates, and psychiatric consultant engagement.
- Overlapping BHI and CoCM Billing
- Mistake: Billing 99484 alongside 99492/99493 in the same calendar month for the same patient.
- Fix: Choose the correct care model code per CMS guidelines; BHI and CoCM are mutually exclusive in the same month.
- Failing to Update Retired Codes
- Mistake: Continuing to bill G0511 after its retirement (effective July 1, 2025).
- Fix: Switch to current CPT/HCPCS codes (e.g., 99484, 99492, 99493) to avoid automatic denials.
- Inaccurate Time Tracking
- Mistake: Documenting insufficient or rounded time that doesn’t meet minimum requirements.
- Fix: Track exact minutes per service; for example, 99484 requires ≥20 minutes, 99492 ≥70 minutes in month 1.
- Incorrect Provider Billing
- Mistake: Using a provider type not eligible for the specific code (e.g., social worker billing CoCM independently).
- Fix: Verify eligibility per code: physicians or QHPs bill CoCM; licensed psychologists or social workers can bill G0323 or join team conference codes.
We Make Behavioral Health Billing Simple For You
Psychiatric care management is a critical service that improves outcomes for millions of patients, and it’s fully reimbursable when coded correctly. The codes are specific, the documentation requirements are strict, and the differences between 99484, 99492, and 99493 matter significantly to your bottom line.
Getting this right means your providers get paid for the work they’re already doing. Getting it wrong means denials, write-offs, and compliance risk.
MedHeave’s behavioral health billing specialists work with these codes daily. We manage BHI and CoCM billing, verify documentation meets CMS standards, and handle denial appeals so your team stays focused on patient care.
If you want to know where your current behavioral health billing stands, start with a free billing audit. Or explore our behavioral health billing services to see how we handle this code set end-to-end.
Frequently Asked Questions
1. What is the difference between CPT 99484 and CPT 99492?
CPT 99484 is flexible for general behavioral health care (≥20 minutes/month). CPT 99492 is for the first month of CoCM, requiring a 3-person team and ≥70 minutes.
2. Can social workers bill independently for behavioral health case management?
Yes, social workers can bill G0323 for general BHI services and join team codes, but usually cannot bill CoCM codes independently unless allowed by state or payer rules.
3. Does Medicare cover care coordination under CPT 99484?
Yes. Medicare reimburses 99484 for provider-directed care management services, requiring an ongoing patient relationship. Always confirm current reimbursement via the CMS Physician Fee Schedule.
4. What ICD-10 codes are used with behavioral health case management CPT codes?
Any mental, behavioral, or psychiatric diagnosis can be used, such as F32.x, F41.1, F10.x–F19.x, or F20.x, whether newly identified or pre-existing.
5. How do behavioral health case management CPT codes apply to telehealth?
These codes can be delivered via telehealth. Use modifier 95 if required, but non-face-to-face 99484 services typically don’t need a telehealth modifier. Confirm payer rules.
6. Can You Bill BHI and CoCM in the Same Month?
No. You cannot bill 99484 (General BHI) and 99492 or 99493 (CoCM) for the same patient in the same calendar month. These represent different care models and are mutually exclusive per CMS guidelines.
7. Can you bill BHI and Chronic Care Management (CCM) together?
Yes, but each requires an independent 20 minutes of service. A total of 40 minutes of documented clinical staff time is needed to bill both in the same month.
