How to Bill Collaborative Care and BHI Codes

Key Takeaways

Medicare pays for behavioral health integration (BHI) through two models: psychiatric collaborative care (CoCM), billed with 99492, 99493, 99494, and G2214, and general BHI, billed with 99484, or with G0323 when a clinical psychologist or clinical social worker is the treating practitioner.
The standalone BHI codes are monthly and time-based, so each claim depends on minutes logged by team member within a single calendar month.
Before the first claim, the patient needs an initiating visit and documented consent that includes notice of cost sharing.
A single practitioner reports either CoCM or general BHI for a patient in a given month, never both.
Since January 1, 2026, practices billing advanced primary care management (APCM) can report BHI add-on codes G0568, G0569, and G0570, which carry no time thresholds.
Also since January 1, 2026, rural health clinics and FQHCs bill the individual collaborative care codes in place of G0512.

Collaborative care and other behavioral health integration codes pay primary care and other treating practices for the work that happens between visits: tracking symptoms, adjusting treatment plans, and consulting with a psychiatrist about patients the consultant may never see. Each claim covers a calendar month and depends on requirements that visit codes do not have, including documented consent, a minimum amount of team time, and no conflicting code billed for the same month.

What Are Behavioral Health Integration Services?

Behavioral health integration services are monthly care management services that a treating practitioner, usually in primary care, bills for managing a patient’s mental health, behavioral health, or substance use condition with the help of a care team. Medicare recognizes two models. Psychiatric collaborative care (CoCM) is a defined team model with a behavioral health care manager and a psychiatric consultant. General BHI covers other integrated care models that do not meet every CoCM requirement.

According to CMS’s BHI frequently asked questions, the codes are not limited to a specified list of conditions and may be used for any mental, behavioral health, or psychiatric condition. The diagnosis can be pre-existing or made by the billing practitioner, and it may be refined over time. PGM’s ICD-10 codes for mental health page lists frequently billed mental health diagnosis codes.

Which Codes Are Used for Collaborative Care and General BHI?

Six codes make up the core BHI code set under the Medicare Physician Fee Schedule. The time thresholds below come from CMS’s Behavioral Health Integration Services booklet (April 2025), and CPT time rules govern how partial thresholds are counted.

Code	Service	Monthly time and who furnishes it
99492	Initial psychiatric collaborative care management, first month	70 minutes of behavioral health care manager time
99493	Subsequent psychiatric collaborative care management	60 minutes of behavioral health care manager time
99494	Collaborative care add-on, initial or subsequent month	Each additional 30 minutes of behavioral health care manager time
G2214	Initial or subsequent collaborative care management	30 minutes of behavioral health care manager time
99484	General behavioral health integration care management	At least 20 minutes of clinical staff time
G0323	Care management for behavioral health conditions	At least 20 minutes of clinical psychologist or clinical social worker time

How Do You Bill Psychiatric Collaborative Care Codes 99492, 99493, and 99494?

The treating practitioner bills collaborative care once per calendar month, and the behavioral health care manager’s minutes determine the code. The first month of an episode requires 70 minutes for 99492, and later months require 60 minutes for 99493. Care manager time past those minimums is reported in 30-minute increments with add-on 99494. G2214 needs only 30 minutes and applies to an initial or subsequent month, so it covers months when the care manager falls short of 70 or 60 minutes.

CoCM requires a three-member team:

Treating practitioner. A physician or non-physician practitioner such as a nurse practitioner or physician assistant, who directs the care team and bills the service.
Behavioral health care manager. A team member with formal education or specialized training in behavioral health who performs the initial assessment, administers validated rating scales, maintains the patient registry, and delivers brief interventions such as behavioral activation or motivational interviewing.
Psychiatric consultant. A medical provider trained in psychiatry and qualified to prescribe the full range of medications. The consultant reviews the caseload with the care manager weekly, recommends treatment changes, and can work remotely.

CoCM runs as an episode of care. The episode ends when the patient reaches the targeted treatment goals, fails to reach them and is referred for direct psychiatric care, or goes six consecutive months without CoCM services.

Time spent solely on administrative or clerical tasks does not count toward any threshold, and minutes can be counted only once even when the same staff member furnishes other billable services.

When Should a Practice Bill General BHI Code 99484?

Code 99484 applies to practices that integrate behavioral health care without a full collaborative care team. It requires at least 20 minutes per calendar month of clinical staff time directed by the billing practitioner. The month’s work must include assessment or follow-up monitoring with applicable validated rating scales, care planning, coordination of treatment such as psychotherapy or pharmacotherapy, and continuity of care with a designated team member. A dedicated behavioral health care manager and psychiatric consultant are optional.

More practitioner types can bill general BHI than CoCM. CMS lists physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse-midwives for 99484, compared with physicians, physician assistants, and nurse practitioners for CoCM.

What Is G0323 and Who Can Bill It?

G0323 is the general BHI code for clinical psychologists and clinical social workers who serve as the treating practitioner. It requires at least 20 minutes of the psychologist’s or social worker’s time per calendar month. A psychiatric diagnostic evaluation (90791) serves as the initiating visit, so behavioral health practices can begin G0323 services without a primary care E/M visit.

What Has to Happen Before the First BHI Claim?

BHI services share three prerequisites, and a claim without them cannot be supported on review even when the monthly time is documented:

Initiating visit. New patients, and patients not seen within the past year, need an initiating visit with the billing practitioner before BHI begins. Qualifying visits include an E/M visit, the Annual Wellness Visit, the Initial Preventive Physical Examination, and transitional care management. For G0323, the initiating visit is 90791.
Patient consent. The patient must agree in advance to receive BHI services, including consultation with specialists such as the psychiatric consultant. Verbal consent is acceptable if it is documented in the medical record.
Cost-sharing notice. The consent discussion must tell the patient that cost sharing applies to both face-to-face and non-face-to-face services, even when a supplemental policy may cover it.

After that, the monthly record needs to show the minutes by team member and date, the activities performed, rating scale results, and any psychiatric consultant recommendations. A time log that cannot be tied to specific activities leaves the claim exposed in a payer review. Tracking minutes as the month progresses, rather than totaling them at month end, leaves room to complete the outreach a patient still needs. Under CMS guidance, the claim can be submitted as soon as the minimum time is met, although care should continue for the rest of the month when medically necessary.

Can BHI Be Billed in the Same Month as CCM, Psychotherapy, or Other Services?

Often yes, with limits that depend on which codes overlap:

CoCM and general BHI. A single practitioner must choose either the CoCM codes or 99484 for a patient in a given month. The practitioner can switch codes from one month to the next.
Chronic care management. BHI can be billed in the same month as chronic care management when the patient has consented to both and the time counted toward each service is distinct. Only one practitioner can report chronic care management for a patient each month.
Services by the care manager. A behavioral health care manager who is eligible to bill Medicare independently, such as an enrolled clinical social worker, may report separate services for the same patient in the same month, including psychiatric evaluation and psychotherapy. Those minutes cannot also count toward the BHI threshold.
APCM add-ons. A practice that reports an APCM behavioral health add-on for a patient cannot also bill 99492, 99493, or 99484 for that patient, according to the National Association of Rural Health Clinics (NARHC).

When the treating practitioner also furnishes psychotherapy, the time-based code and add-on rules in PGM’s breakdown of the coding and billing mistakes behind denied behavioral and mental health claims apply.

How Do the 2026 APCM Behavioral Health Add-On Codes Work?

For 2026, CMS finalized three optional add-on codes that let practices billing advanced primary care management (APCM) report behavioral health integration as part of that service. According to the CY 2026 Physician Fee Schedule final rule summary, the add-ons are billed when the same practitioner reports the APCM base code in the same month, and they are meant to be directly comparable to the existing CoCM and general BHI codes.

G0568 corresponds to initial-month collaborative care (99492).
G0569 corresponds to subsequent-month collaborative care (99493).
G0570 corresponds to general BHI (99484).

The add-ons, like the APCM base codes, do not require tracking minutes, and CMS created no counterpart to 99494 because that code is defined by time, according to the American College of Physicians’ summary of the final rule. In place of time, NARHC’s summary describes the add-ons as requiring that behavioral health services be available to the patient, along with care team collaboration such as treatment planning and progress tracking. Documentation should show that collaboration for each month an add-on is billed.

How Do Rural Health Clinics and FQHCs Bill Collaborative Care in 2026?

Starting January 1, 2026, rural health clinics and federally qualified health centers bill the individual collaborative care codes (99492, 99493, 99494, and G2214) in place of the bundled code G0512. NARHC’s summary of the CY 2026 final rules also notes that G0511, the bundled general care management code, stopped being payable for RHCs on October 1, 2025. Both settings can also report the APCM behavioral health add-ons with their APCM services.

How PGM Supports Behavioral Health Integration Billing

PGM has provided independent medical billing and revenue cycle management since 1981 for primary care groups and for mental and behavioral health practices. Services include eligibility and benefits verification, coding review, claims submission, denial management and appeals, and payment posting and reporting across commercial, Medicare, and Medicaid payers.

If your practice is launching collaborative care or seeing denials on BHI claims, talk to PGM’s behavioral health billing team. Primary care practices can also learn more about PGM’s primary care billing services and the revenue cycle pressures facing primary care in 2026.

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Frequently Asked Questions About Collaborative Care and BHI Billing

Can a psychiatrist bill the collaborative care codes?

In collaborative care, the psychiatrist usually serves as the psychiatric consultant to a treating practitioner, and CMS has said it would not expect psychiatrists to bill the CoCM codes. A psychiatrist who furnishes general BHI can bill 99484.

Does the behavioral health care manager have to be on site?

No. The care manager must be available to provide face-to-face services, but in-person contact is not mandatory, and CMS’s BHI FAQs state that care team members may work offsite, including from home, when furnishing services remotely.

Do commercial payers and Medicaid cover collaborative care codes?

Coverage varies by payer, plan, and state. Some commercial plans and state Medicaid programs pay the CoCM and general BHI codes, and others do not or apply different rules. When a plan carves out behavioral health benefits, the claim may belong to a separate managed behavioral health organization, which is covered in PGM’s post on behavioral health carve-outs. Verify coverage and claim routing before launching a program for a payer’s members.

Does BHI consent have to be renewed every month?

No. According to CMS’s BHI FAQs, consent does not have to be renewed monthly or annually. A new consent is required only when the patient changes billing practitioners, and the new practitioner must obtain and document it before furnishing services.

Which place of service goes on a BHI claim?

The place of service is the location where the billing practitioner would ordinarily see the patient face to face, even though most BHI work happens outside a visit. That rule holds when the patient spends part or all of the month in a hospital, nursing facility, or other institutional setting, and CMS prices the BHI codes for both facility and non-facility settings.