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CPT 99493
Description, Billing Rules, and Use Cases

CPT 99493 is used to report Collaborative Care Model (CoCM) services provided during subsequent months of integrated behavioral health care. This code covers up to 60 minutes of time spent by a behavioral health care manager, under the supervision of a billing provider, and in consultation with a psychiatric consultant.


CPT 99493 may be billed once per calendar month per patient after the initial month (billed under CPT 99492). If time exceeds 60 minutes, use CPT 99494 to report each additional 30-minute block of care.

What is CPT Code 99493?

CPT 99493 is a monthly billing code used for ongoing psychiatric Collaborative Care Model (CoCM) services. It applies after the initial month (covered by CPT 99492) and reflects continued engagement of a collaborative care team, including a behavioral health care manager (BHCM), a psychiatric consultant, and a billing physician or QHP.

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Use CPT 99493 when:

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  • A behavioral health diagnosis is being managed through an ongoing CoCM care plan

  • A psychiatric consultant is involved in care planning and supervision

  • The BHCM continues to coordinate care and engage with the patient

  • At least 31 minutes of total CoCM activity occurs in a follow-up calendar month

  • Services include:

    • Tracking patient progress using validated tools (e.g., PHQ-9, GAD-7)

    • Adjusting treatment plans based on psychiatric recommendations

    • Communicating across the care team and documenting all interactions

 

CPT 99493 may be reported once per month, for each month after CoCM is initiated. Use CPT 99494 to report additional time beyond 60 minutes.

CPT 99493 Billing Requirements and Eligibility

CPT 99493 is used to report subsequent-month Collaborative Care Model (CoCM) services after the initial calendar month billed under CPT 99492. It covers up to 60 minutes of team-based behavioral health management and is used once per patient per month when CoCM continues beyond month one.

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To bill CPT 99493, the following requirements must be met:

Patient Eligibility Criteria

  • The patient must have a behavioral health diagnosis, such as:

    • Major depressive disorder (MDD)

    • Generalized anxiety disorder (GAD)

    • PTSD or trauma-related disorder

    • Substance use disorder

  • The patient is actively engaged in an ongoing CoCM care plan

Care Plan Requirements

  • A structured behavioral health care plan must be:

    • Reviewed and updated as needed during the billing month

    • Based on structured assessments such as PHQ-9 or GAD-7

    • Shared among the CoCM team and documented in the medical record

    • Focused on clinical goals, treatment progress, and outcome tracking

Care Team Requirements

  • The billing provider (physician, NP, or PA) supervises the CoCM process

  • A behavioral health care manager (BHCM) performs non-face-to-face services and coordinates care

  • A psychiatric consultant must be:

    • Available for ongoing case review

    • Providing documented treatment input

    • Not directly seeing the patient

  • All team members must be documented by name and role. There must be active communication and coordination among them.

Service and Time Requirements

  • At least 31 minutes of non-face-to-face CoCM services must be provided during the billing month

  • Activities must include:

    • Review of patient symptoms and clinical outcomes

    • Adjustments to the care plan or medication recommendations

    • Case consultation between BHCM, psychiatric consultant, and billing provider

    • Follow-up with the patient or caregiver

  • All time must be:

    • Non-face-to-face

    • Distinct from time billed under other care management codes

    • Logged accurately with date, activity, and duration

Billing Limitations

  • CPT 99493 may be billed once per patient per calendar month, beginning with the second month of CoCM services

  • If CoCM services extend beyond 60 minutes, CPT 99494 may be added for each additional 30-minute block

  • Do not bill CPT 99493 in the same month as:

CPT 99493 Billing Documentation Checklist

To support compliant billing of CPT 99493, the following elements must be documented clearly in the medical record:

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  • A behavioral health diagnosis must be active and documented

    • Examples include MDD, GAD, PTSD, or substance use disorder

    • Diagnosis should remain the focus of care during the billing month

  • A structured CoCM care plan that was:

    • Reviewed or revised during the billing period

    • Based on validated tools like PHQ-9, GAD-7, or AUDIT-C

    • Integrated with the patient’s broader care strategy

    • Documented with behavioral goals, clinical outcomes, and follow-up intervals

  • A clearly defined CoCM care team, including:

    • Billing provider (physician, NP, or PA)

    • Behavioral health care manager (BHCM)

    • Psychiatric consultant (psychiatrist or clinical psychologist)

  • At least 31 minutes of non-face-to-face CoCM services performed in the calendar month

    • Documented with:

      • Time logs or cumulative totals

      • Specific dates and activities

      • Role of each team member

  • Activities may include:

    • Symptom tracking and outcome measurement

    • Behavioral health care plan adjustments

    • Consultation with the psychiatric provider

    • BHCM-led patient outreach or coaching

    • Internal communication among the CoCM team

  • Evidence of psychiatric consultant input, such as:

    • Recommendations to the BHCM or billing provider

    • Medication adjustments, diagnostic clarification, or care plan support

  • A note from the billing provider confirming:

    • Oversight of the CoCM process

    • Review of BHCM documentation and patient progress

    • Continued clinical responsibility for the behavioral health condition

CPT 99493 Time Thresholds and Code Combinations

CPT 99493 is used to report up to 60 minutes of non-face-to-face Collaborative Care Model (CoCM) services in any month following the initial CoCM period (which is billed under CPT 99492). Time is accrued across the entire CoCM team, including the behavioral health care manager, psychiatric consultant, and billing provider.

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Use the chart below to determine how to report time spent:

Time-based billing chart for CPT 99493 showing thresholds for psychiatric collaborative care in subsequent months, including when to add CPT 99494.

Important to Note:

CPT 99493 may be billed once per calendar month after the CoCM care plan has been initiated under CPT 99492.
If the total collaborative time exceeds 60 minutes, add CPT 99494 once for each additional 30-minute block.


Time must be:

  • Non-face-to-face

  • Spent by members of the CoCM team working together under the billing provider’s direction

  • Focused specifically on managing a behavioral health condition

  • Distinct from time billed under any other care management models (e.g., CCM, PCM, TCM, general BHI)

When to Use CPT 99493:
Common Scenarios and Use Cases

CPT 99493 should be used when a Collaborative Care Model (CoCM) care team delivers at least 31 minutes of psychiatric integration services in a calendar month after the first month. Services must be non-face-to-face and involve structured collaboration between a behavioral health care manager, a psychiatric consultant, and the billing provider.

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Here are examples of how CPT 99484 is used in practice:

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  • Ongoing Depression Monitoring With BHCM Support
    A BHCM:

    • Reassesses the patient’s PHQ-9 score

    • Coordinates with the psychiatric consultant regarding symptom plateau

    • Updates the care plan and communicates changes to the PCP

    • Provides adherence support through weekly phone check-ins
      Total time: 45 minutes
      Billing: 99493

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  • Anxiety and Sleep Disturbance Requiring Psychiatric Input
    During a follow-up month, the BHCM:

    • Tracks symptom improvement using GAD-7

    • Consults with the psychiatric provider about adjusting SSRI dosage

    • Engages the patient in self-management education

    • Updates the primary care provider with next steps
      Total time: 58 minutes
      Billing: 99493

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  • Dual-Diagnosis Patient Requiring Escalated Support
    A BHCM:

    • Conducts weekly check-ins to assess PTSD and substance use symptoms

    • Coordinates with the psychiatric consultant on tapering a sedative

    • Revises the care plan twice during the month due to high-risk status

    • Works with the PCP to manage cross-team updates
      Total time: 88 minutes
      Billing: 99493 + 99494

Common CPT 99493 Billing Mistakes
(and How to Avoid Them)

CPT 99493 is often misused when teams conflate care models or overlook key time and team-based documentation requirements. Watch for these common errors to ensure accurate billing:

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  • ❌ Billing 99493 Without Prior CoCM Initiation (99492)
    CPT 99493 may only be billed after the first calendar month of Collaborative Care services. If the patient is new to CoCM, you must start with CPT 99492.
     

  • ❌ Reporting Fewer Than 31 Minutes of CoCM Time
    You must document at least 31 minutes of collaborative, non-face-to-face psychiatric care to bill 99493. Anything less is not billable.
     

  • ❌ Counting Provider Time Only

    • This code requires team-based time, including contributions from the behavioral health care manager, psychiatric consultant, and billing provider. Standalone provider time does not qualify.
       

  • ❌ Overlapping With Other Care Management Codes

    • Do not bill 99493 in the same month as:

      • 99484 (general BHI)

      • 99490–99491 (CCM)

      • 99424–99427 (PCM)

      • 99487–99489 (complex CCM)

      • 99495–99496 (TCM)

    • Each model is mutually exclusive and time may not be shared across services.
       

  • ❌ Missing Documentation of Psychiatric Consultant Involvement​​

    • The psychiatric consultant must:

      • Be clearly identified in the record

      • Provide clinical recommendations that inform the treatment plan

      • Not directly see the patient
        Lack of consultant documentation is a common cause of denials.
         

  • ❌ No Evidence of Care Plan Updates or Outcome Tracking​​

  • There must be:

    • A structured, updated behavioral health care plan

    • Use of validated tracking tools (PHQ-9, GAD-7)

    • Progress notes and coordination logs from the BHCM

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