Collaborative Care Codes

Policy ID: BH 100

Section: Behavioral Health

Effective Date: January 01, 2027

Last Reviewed: June 10, 2026

Applies To: Migrated Commercial

This policy applies to all physicians, other health care professionals, hospitals, and other facilities.

Definitions

Code/Term

Code Description/Term Definition

Advanced Primary Care Management (APCM)

A combination of several existing care management and communication technology-based services that allows a provider to provide patients with a wide range of services to meet their individual needs based on complexity and ensures that the patient has access to high-quality primary care services.

Behavioral Health Care Manager (BHCM)

Typically, a clinical social worker, licensed counselors, nurses, and psychologists; however, in some contexts, they may not be a licensed provider.

BHCMs are an integral part of the team approach that supports the PCP in their role by coordinating the overall treatment plan, providing brief psychotherapy, supporting medication management, alerting the PCP when the patient is not improving, and communicating with the psychiatric consultant.
BHCMs facilitate communication among all team members and act as the lead contact person for the patient.

Collaborative Care Model (CoCM)

Is a specific type of integrated care that treats common mental/behavioral health conditions such as depression, anxiety, PTSD, alcohol or substance use disorders.

Primary Care Physician or appropriate Qualified Health Care Professional (QHP)

Physicians (Medical Doctor [MD], Doctor of Osteopathic [DO], Non-Physician Practitioner [NPP], Physician Assistant/Physician Associate [PA] and Nurse Practitioner [NP]).

These are typically primary care but may be of another specialty such as cardiology or oncology. Oversee all aspects of a patient’s behavioral health care including encouraging the patient’s participation, prescribing medications and making referrals to specialty mental health care when needed.

Psychiatric Consultant

A Board Certified Psychiatrist, Board Certified Psychiatric Mental Health Practitioner or Board Certified Psychiatric Advanced Registered Nurse Practitioner. Provides support to the PCP and BHCM in treating patients with behavioral health illnesses. These providers must be allowed to practice independently by their state licensing boards.

99492

Initial psychiatric collaborative care management, first70 minutes in the first calendar month of Behavioral Health/Collaborative Management (BHCM) activities, in consultation with a psychiatric consultant, and directed by the treating physician or other Qualified Health Professional (QHP), with the following required elements:

Outreach to and engagement in treatment of a patient directed by the treating physician or other QHP
Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan
Review by the psychiatric consultant with modifications of the plan if recommended
Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies.

99493

Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP, with the following required elements:

Tracking patient follow-up and progress using the registry, with appropriate documentation
Participation in weekly caseload consultation with the psychiatric consultant
Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other QHP and any other treating mental health providers
Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies
Monitoring of patient outcomes using validated rating scales; and
Relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.

99494

Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP (List separately in addition to code for primary procedure) (Use 99494 in conjunction with 99492, 99493).

G0323

Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month, with the following required elements:

Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes
Facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by Medicare to prescribe medications and furnish E/M services, counseling and/or psychiatric consultation; and
Continuity of care with a designated member of the care team

G0568

Initial psychiatric collaborative care management, in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements:

Entering patient in a registry and tracking patient follow-up and progress using the registry, with
Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan
Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies (list separately in addition to the advanced primary care management code)
Review by the psychiatric consultant with modifications of the plan if recommended

G0569

Subsequent psychiatric collaborative care management, in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements:

Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant
Monitoring of patient outcomes using validated rating scales
Ongoing collaboration with and coordination of the patient's mental health care with the treating
Participation in weekly caseload consultation with the psychiatric consultant
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
Relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment (list separately in addition to advanced primary care management code)
Tracking patient follow-up and progress using the registry, with appropriate documentation

G2214

Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.

Tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant
Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers
Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations supplied by the psychiatric consultant
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
Monitoring of patient outcomes using validated rating scales
Relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment)

Policy Statement

Our health plan follows Centers for Medicare & Medicaid Services (CMS) guidelines for psychiatric collaborative care services. In the Psychiatric Collaborative Care Model (CoCM), patients are cared for through a team approach, involving a primary care physician or practitioner, behavioral health care manager and a psychiatric consultant. CoCM focuses on defined patient-centered team care, population-based care, measurement-based treatment to target, evidence-based care and accountable care. Trained primary care/specialty licensed medical providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who are not improving as expected.

CoCM Service Components:

Initial assessment: The primary care team assesses patients and administers validated rating scales.

Joint care planning: The primary care team works with the patient to revise the care plan if the condition isn’t improving adequately. Treatment may include pharmacotherapy, psychotherapy, or other recommended treatments.

Ongoing follow-up: The behavioral health care manager follows up proactively and systematically using validated rating scales and a registry.
- Assesses treatment adherence, tolerability, and clinical response using validated rating scales
- Delivers brief, evidence-based psychosocial interventions such as behavioral activation or motivational interviewing
- Provides 70 minutes of behavioral health care manager time in the first month, 60 minutes in following months, and an add-on code adds 30 more minutes in any month

Systematic case review: The behavioral health care manager and psychiatric consultant conduct regular caseload reviews:
- The behavioral health care manager and psychiatric consultant review the patient’s treatment plan and status weekly, and if the patient isn’t improving, discuss potential revisions
- The primary care team continues or adjusts treatment, including referral to behavioral health specialty care, as needed

Our health plan will reimburse appropriate licensed medical practitioners for the psychiatric collaborative care codes 99492 – 99494, G0323, G0568, G0569 and G2214 only when they have followed the Collaborative Care model.

Our health plan will not reimburse CoCM codes when a psychiatric consultant provides direct patient care and bills the services under their own NPI.

Reimbursement is available for CoCM add-on codes G0568 and G0569 when performed in the same month as Advanced Primary Care Management (APCM) Services. All requirements must be met and a APCM base code G0556, G0557, or G0558 must be billed in the same month as the CoCM add-on code.

References

Cross References

Adm 129 - Correct Coding Guidelines
Adm 107 - Non-Reimbursable Services

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.

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