Author: GDIT, (800) 688-6696
Psychiatric collaborative care management services must be rendered under the direction of a treating physician or non-physician practitioner (NPP), typically in a primary care setting. These services are rendered when a beneficiary has a diagnosed psychiatric disorder and requires assessment, care planning and provision of brief interventions. These beneficiaries may require assistance engaging in treatment or further assessment prior to being referred to a psychiatric care setting.
The following psychiatric collaborative care management codes may only be billed by the primary care provider directing the service; they may not be billed by the behavioral health care manager or the psychiatric consultant:
• 99492 – Initial psychiatric collaborative care management, first 70 minutes in the first calendar month
• 99493 – Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities
• 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month
Additional Billing Guidelines
• Evaluation and management (E/M) and other services may be reported separately by the same physician or NPP during the same calendar month.
• If the treating physician or NPP personally performs behavioral health care manager activities and those activities are not used to meet criteria for a separately reported service, his or her time may be counted toward the required behavioral health care manager time to meet the elements of 99492, 99493, or 99494.
• The behavioral health care manager may report separate services such as therapy, psychiatric evaluation, tobacco cessation, or substance use services during the same calendar month. Activities for separately reported services are not included in the time applied to psychiatric collaborative care management.
• Behavioral health care manager time spent coordinating care with the emergency department may be reported using 99492, 99493, or 99494, but time while the beneficiary is inpatient or admitted to observation status may not be reported using psychiatric collaborative care management codes.
• The psychiatric consultant may provide services such as E/M services and psychiatric evaluations and these services may be separately reported. Activities for services separately reported are not included in the reporting of psychiatric collaborative care management.
• Behavioral health care managers and psychiatric consultants who prescribe medication or make direct referrals for Medicaid beneficiaries must be actively enrolled in NC Medicaid. If they bill for separately reimbursable services, they must be enrolled with a behavioral health Local Management Entity /Managed Care Organization for billing.
Refer to the 2018 Current Procedural Terminology (CPT) manual, published by The American Medical Association (AMA) for more information regarding psychiatric collaborative care management codes and requirements.