CPT 99494 is an add-on billing code for Collaborative Care Model (CoCM) services. It is used when total time exceeds 70 minutes in the first month or 60 minutes in subsequent months. Each unit represents an additional 30-minute block of team-based psychiatric care.

When should CPT 99494 be billed?

CPT 99494 should be billed when the total time spent delivering CoCM services exceeds the thresholds for CPT 99492 (70 minutes) or CPT 99493 (60 minutes).

Can CPT 99494 be billed on its own?

No. CPT 99494 is an add-on code and must be billed in conjunction with either CPT 99492 or 99493.

How many units of CPT 99494 can be billed?

Multiple units of CPT 99494 may be billed as long as total documented CoCM time supports each additional 30-minute block beyond the base code threshold.

What documentation is required for CPT 99494?

Documentation must show total time spent, care team roles, psychiatric consultant input, and activities performed during the additional time. All time must be non-face-to-face and clearly logged.

CPT 99494
Description, Billing Rules, and Use Cases

CPT 99494 is an add-on billing code used to report each additional 30-minute block of Collaborative Care Model (CoCM) services beyond the time covered under CPT 99492 or 99493.

It applies to non-face-to-face psychiatric care delivered by a behavioral health care manager, in collaboration with a psychiatric consultant and under the supervision of a billing provider.

This code can be billed alongside 99492 or 99493 when total CoCM time exceeds the base threshold — but may never be billed alone.

What is CPT Code 99494?

CPT 99494 is an incremental, time-based add-on code used within the Collaborative Care Model for behavioral health integration. It reflects continued patient engagement and care team coordination when total monthly CoCM time exceeds the limits of 99492 or 99493.

Use CPT 99494 when:

You have already billed 99492 (initial month) or 99493 (subsequent months)

Total collaborative care time reaches:

71+ minutes in the first month (99492 + 99494)

61+ minutes in ongoing months (99493 + 99494)

The care team includes:

A behavioral health care manager (BHCM)

A psychiatric consultant

A billing provider (physician, NP, or PA)

The code is used to report:

Each additional 30-minute block of non-face-to-face team-based psychiatric care

Services like case review, outcome tracking, care plan updates, and treatment coordination across the care team

CPT 99494 is only valid as an add-on to 99492 or 99493. Time must be clearly documented, and the patient must remain in an active CoCM care plan.

CPT 99493 Billing Requirements and Eligibility

CPT 99494 is an add-on code used to report each additional 30-minute block of Collaborative Care Model (CoCM) services beyond the base time covered by CPT 99492 (first month) or CPT 99493 (subsequent months). It reflects ongoing behavioral health care coordination between a behavioral health care manager, a psychiatric consultant, and a billing provider.

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

Patient Eligibility Criteria

The patient must have an active behavioral health diagnosis, such as:
- Major depressive disorder
- Generalized anxiety disorder
- PTSD or trauma-related disorder
- Substance use disorder
The patient must already be enrolled in an active CoCM care plan
The patient’s CoCM time has already reached the threshold for billing 99492 or 99493

Care Plan Requirements

The CoCM care plan must be:
- Established in a prior month (under 99492)
- Updated or maintained in the current month
- Focused on measurable behavioral health outcomes
- Supported by validated assessment tools (e.g., PHQ-9, GAD-7)
- Shared and documented across the care team

Care Team Requirements

The CoCM team must include:
- A billing provider (physician, NP, or PA)
- A behavioral health care manager (BHCM)
- A psychiatric consultant available for treatment input
All roles must be documented by name and must collaborate on the patient’s care

Service and Time Requirements

CPT 99494 may only be billed if total CoCM time exceeds:
- 70 minutes in the first month (with 99492)
- 60 minutes in any subsequent month (with 99493)
Each unit of 99494 represents an additional 30-minute block
All time must be:
- Non-face-to-face
- Delivered by the full CoCM team
- Accurately tracked and documented

Billing Limitations

CPT 99494 may never be billed on its own
It must always appear in conjunction with CPT 99492 or 99493
Do not bill CPT 99494 in the same month as:
- 99484 (general BHI)
- 99490–99491 (CCM)
- 99424–99427 (PCM)
- 99487–99489 (complex CCM)
- 99495–99496 (TCM)

Billing Documentation Checklist

CPT 99494 is a time-based add-on code and requires precise documentation of extended CoCM activity. To compliantly bill 99494, ensure the following are included in the patient’s medical record:

A behavioral health diagnosis remains active and is the primary focus of care
- Example: MDD, GAD, PTSD, substance use disorder
- Diagnosis must be supported by ICD-10 and structured screening results (e.g., PHQ-9)

A CoCM care plan is:
- Already in place (initiated under 99492)
- Maintained and updated during the billing month
- Shared across the team, with clearly documented clinical goals and interventions

The full CoCM care team is active and documented:
- Billing provider (physician, NP, or PA)
- Behavioral health care manager (BHCM)
- Psychiatric consultant contributing treatment recommendations
- Each team member identified by name and role

A base code (CPT 99492 or 99493) has been or will be billed in the same month
- CPT 99494 may not be billed independently

Documented total time exceeds the base code threshold:
- More than 70 minutes total in the initial month (99492 + 99494)
- More than 60 minutes total in subsequent months (99493 + 99494)
- Time should be logged in a clear and auditable format (date, activity, duration)

Activities performed during additional time must include:
- Outcome tracking or clinical assessment
- BHCM-patient follow-up
- Psychiatric case review and care plan revisions
- Interprofessional communication or coordination

Provider attestation should confirm:
- Review of the care plan and BHCM documentation
- Active coordination with the psychiatric consultant
- Supervision of the CoCM process and continued care oversight

CPT 99494 Time Thresholds and Code Combinations

CPT 99494 is an add-on code used to report each additional 30-minute block of time spent delivering Collaborative Care Model (CoCM) services after the base time thresholds for CPT 99492 or 99493 have been met. This code reflects continued non-face-to-face psychiatric care coordination delivered by the CoCM team.

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

Time-based billing chart for CPT 99494 showing when to report add-on units in conjunction with CPT 99492 or 99493, depending on total CoCM time.

Important to Note:

CPT 99494 may only be billed with CPT 99492 or 99493 and never on its own.

It reflects each additional 30-minute block of CoCM time once:

70 minutes are exceeded in the first month, or
60 minutes are exceeded in ongoing months
All billed time must be:
Non-face-to-face
Logged with date, duration, and activity
Performed by the full CoCM team under provider supervision
Distinct from any other care management billing

When to Use CPT 99494:
Common Scenarios and Use Cases

CPT 99494 should be used when total CoCM time exceeds the base thresholds covered by CPT 99492 (first month) or CPT 99493 (ongoing months). Each unit of 99494 accounts for one additional 30-minute block of time and reflects extended care team collaboration.

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

First Month With High Engagement
During the first calendar month of CoCM services, the BHCM:
- Completes two structured assessments (PHQ-9 and GAD-7)
- Consults with a psychiatrist regarding SSRI initiation
- Reviews and updates the care plan twice
- Engages the patient’s caregiver by phone
  Total time: 95 minutes
  Billing: 99492 + 99494

Ongoing Depression Monitoring Requiring Extended Time
During a follow-up month, the BHCM:
- Tracks PHQ-9 and coordinates with the PCP on tapering medication
- Consults the psychiatric provider twice regarding insomnia
- Logs multiple follow-ups and education sessions for the patient
  Total time: 115 minutes
  Billing: 99493 + 99494 ×2

Complex Dual Diagnosis With Multiple Team Touchpoints
The BHCM manages a patient with comorbid PTSD and alcohol use disorder:
- Tracks GAD-7 and AUDIT-C weekly
- Holds three structured team meetings
- Revises the care plan after each psychiatric review
- Documents extensive patient communication and provider coordination
  Total time: 130 minutes (initial month)
  Billing: 99492 + 99494 ×2

Common CPT 99494 Billing Mistakes
(and How to Avoid Them)

CPT 99494 is a frequently misunderstood code due to its add-on status and strict time requirements. Avoid these common pitfalls to ensure accurate claims and reduce denials:

❌ Billing 99494 Without a Base Code (99492 or 99493)
CPT 99494 may never be billed alone. It must appear on the same claim as either CPT 99492 (initial month) or 99493 (ongoing months). Billing it independently will result in rejection.
❌ Reporting Less Time Than Required
- CPT 99494 requires total CoCM time to exceed:
  - 70 minutes in the first month (with 99492)
  - 60 minutes in subsequent months (with 99493)
    If total time doesn’t cross the threshold, 99494 cannot be used — even if the month felt “busy.”
❌ Overlooking the Need for Team-Based Care
- Time reported under 99494 must be collaborative and involve:
  - A behavioral health care manager actively working with the patient
  - A psychiatric consultant offering treatment input
  - A billing provider overseeing and reviewing all care
    Solo staff time or basic outreach doesn’t qualify.
❌ Stacking 99494 Without Matching Documentation
- You can bill multiple units of 99494, but only if documentation supports:
  - Total CoCM time
  - Distinct 30-minute blocks
  - Logged dates, durations, and descriptions of services
❌ Billing With Conflicting Care Management Codes
- CPT 99494 cannot be billed in the same month as:
  - 99484 (general BHI)
  - 99490–99491 (Chronic Care Management)
  - 99424–99427 (Principal Care Management)
  - 99487–99489 (Complex CCM)
  - 99495–99496 (TCM)
    Each program is mutually exclusive. Only one set of care management codes may be billed per month per patient.

CPT 99494 Description, Billing Rules, and Use Cases