Depression, anxiety and substance use already fill your primary care schedule, and CPT 99484 may describe work your team does for those patients every month. CPT 99484 is the code for general behavioral health integration (BHI), and 99492, 99493 and 99494 cover the psychiatric Collaborative Care Model (CoCM). Using rules from the Centers for Medicare & Medicaid Services (CMS), this guide covers what each code requires, what changed for 2026, common mistakes and how to choose a model. It also makes a point that’s easy to miss: a billing code doesn’t make you competent to manage psychiatric medication. Elite NP’s Integrative Psychiatric Mental Health Certification builds that clinical side, plus the operations to run it. 

The short answer: CPT 99484 is the monthly code for general behavioral health integration (BHI). It covers at least 20 minutes of care management per calendar month for a patient’s mental or behavioral health condition, directed by a physician, NP, PA or other eligible practitioner. Each month must include assessment or monitoring, care planning, coordinated treatment and continuity with an appointed care team member. The patient must consent first. 

This guide summarizes Medicare rules from CMS sources as of the CY2026 Physician Fee Schedule. It is not coding or legal advice: confirm with your Medicare Administrative Contractor and a certified coder before you bill. 

Want the clinical skills behind the code? Elite NP’s Integrative Psychiatric Mental Health Certification trains NPs and PAs to assess, prescribe for and follow psychiatric patients. 

What CPT 99484 covers: general behavioral health integration 

Medicare covers two kinds of BHI: the psychiatric Collaborative Care Model and general BHI, meaning any other care model. A patient qualifies with any mental, behavioral or psychiatric condition, including substance use disorder, that in your judgment warrants BHI. There’s no diagnosis list (CMS BHI FAQ #9). 

Time and required elements. 99484 requires at least 20 minutes of clinical staff time per calendar month, directed by a physician or other qualified health care professional, and CPT time rules apply. Each month must include (CMS MLN booklet, p. 10): 

• an initial assessment or follow-up monitoring, using applicable validated rating scales 

• care planning, revised when the patient isn’t progressing or their status changes 

• facilitating and coordinating treatment, such as psychotherapy, pharmacotherapy, counseling or psychiatric consultation 

• continuity of care with an appointed care team member 

Who bills. Practitioners whose scope includes evaluation and management (E/M) services and who bill Medicare independently: nurse practitioners, physician assistants, physicians, clinical nurse specialists and certified nurse midwives (FAQ #13). 

Who counts as clinical staff. You can deliver 99484 yourself or with clinical staff: people doing clinical, not clerical, work “incident to” your services under your general supervision, subject to state law, licensure and scope of practice. They can be employees or contractors (FAQ #14). 

Initiating visit. New patients, or patients you haven’t seen within a year, need a qualifying visit first: an E/M visit at levels 2 to 5, an annual wellness visit, an initial preventive physical exam or a transitional care management visit, at which you discuss BHI. A 99211 or telephone visit doesn’t qualify (FAQ #18). 

Consent. Before services start, the patient must agree to your consulting relevant specialists, including a psychiatric consultant, and be told that cost sharing applies. Verbal consent is fine if you document it. You need a new consent only if the billing practitioner changes (FAQ #16–17). 

Team members can work remotely (FAQ #22). A sister code, G0323, covers similar care management by a clinical psychologist or clinical social worker (booklet, p. 10). 

The collaborative care model: 99492, 99493, 99494 and G2214 

CoCM adds care management and regular psychiatric consultation to primary care, delivered by a team of three (booklet, p. 5): 

• Treating (billing) practitioner: a physician, NP or PA, usually in primary care. You direct the care manager, prescribe and refer. 

• Behavioral health care manager: someone trained in behavioral health, for example in social work, nursing or psychology, who is available to see patients face to face. CMS sets no minimum education level (FAQ #5). 

• Psychiatric consultant: a medical provider trained in psychiatry who can prescribe the full range of medications. The consultant can work remotely and usually doesn’t see or prescribe for the patient. 

The care manager tracks patients in a registry, measures progress with validated rating scales, delivers brief interventions such as behavioral activation, and reviews the caseload with the psychiatric consultant weekly. That systematic case review is where treatment changes are recommended for patients who aren’t improving. 

CMS’s G2214 example (booklet, p. 8): you start CoCM, then hospitalize or refer the patient before the month reaches the 99492 or 99493 minutes. CPT time rules apply, so have your coder confirm how partial time counts. An episode ends when goals are met, when they aren’t and the patient is referred for direct psychiatric care, or after six months in a row without CoCM. 

Primary care mental health integration: which model fits your practice? 

You can’t bill 99484 and CoCM for the same patient in the same month, but you can switch between them across months (booklet, p. 9). BHI can share a month with chronic care management if each service has its own consent, each meets its own requirements and no time counts twice (FAQ #2). 

What changed for 2026 

• APCM add-ons. Since January 1, 2026, practices billing advanced primary care management (APCM) can add G0568 (first CoCM month) or G0569 (later CoCM months), or G0570 for general BHI. They need an APCM base code from the same practitioner in the same month. They aren’t time-based, but CMS still expects each required element to be documented (booklet, p. 13; CY 2026 PFS final rule). 

• Rural health clinics and federally qualified health centers. Since January 1, 2026, they bill the individual CoCM codes (99492, 99493, 99494 and G2214) instead of G0512, and they can use the APCM add-ons. Both booklets list 99484 among their care coordination codes (FQHC booklet; RHC booklet). 

• Digital mental health treatment. G0552 to G0554, added for 2025, cover supplying an FDA-authorized digital therapy device and managing its use within a behavioral health treatment plan. For 2026, CMS extended them to ADHD devices (MLN Matters MM14315). 

For 2027, CMS has proposed revaluing the CoCM codes (99492–99494, G2214, G0568 and G0569) but no change to the time, team or consent rules above. Check the final rule before January 2027 (CY 2027 PFS proposed rule). For payment rates, use the CMS Physician Fee Schedule Look-Up Tool, not figures quoted online. Medicaid and commercial plans set their own policies. 

Common 99484 and collaborative care billing mistakes 

The first six leave a Medicare claim without something CMS requires: 

1. Consent not documented, including the cost-sharing discussion. 

2. No qualifying initiating visit for a new patient or one not seen within a year. 

3. Time not tracked, or time that doesn’t count. The time-based codes need their minutes, so keep a log of minutes and who provided them. Clerical time doesn’t count, and psychotherapy or chronic care management minutes can’t count twice. 

4. 99484 and CoCM in the same month for the same patient. 

5. CoCM without the full model: no psychiatric consultant, registry, weekly review or rating scales. 

6. Wrong place of service. Report where you’d normally see the patient face to face (FAQ #11). 

7. Applying Medicare’s rules to every payer. These are Medicare Part B rules; Medicaid and commercial plans set their own. 

What the course adds: The certification covers what this article leaves out: 

– How to choose a practice model and set up a psychiatric practice (How to Open a Psychiatric Practice) 

– How coding, billing, documentation, consent forms and policies fit together in a psychiatric practice 

– How to document and code psychiatric visits as a non-psychiatric provider (Clinical Psychiatry for APPs) 

– The prescribing decisions behind a care plan, and when to refer 

Billing codes don’t make you competent to manage psychiatric medication 

CMS expects the treating practitioner to direct the team, oversee care including prescribing, and stay involved through ongoing reassessment (booklet, p. 11). In CoCM, the psychiatric consultant recommends changes but isn’t generally expected to see the patient or prescribe (booklet, p. 12). The prescription, the dose change and the safety call usually stay with you. CMS’s coding table even assumes some of your own time: 15 minutes for 99484 and 30 minutes for the first CoCM month (booklet, p. 13). Under general BHI, there may be no psychiatrist involved at all. 

The codes pay for structure: minutes, registries and reviews. They don’t teach you to tell bipolar depression from unipolar depression, choose and monitor a medication, or spot a patient who needs a psychiatrist today. And primary care already carries this work: in national data from 1996 to 2007, nearly four in five antidepressant prescriptions were written by clinicians who weren’t psychiatrists (Mojtabai & Olfson, Health Affairs, 2011). 

For suicidal intent or a plan, or new psychosis or mania, arrange emergency care the same day and share the 988 Suicide & Crisis Lifeline (call or text 988). 

Why mental health in primary care is a growth area for NP and PA practices 

The need is large, and the codes are underused. As of December 31, 2025, more than 137 million people in the US lived in a mental health professional shortage area, and those areas had about 27% of the psychiatrists they need (KFF, HRSA data). Yet in 2023, only about 173,800 people with Medicare, roughly 0.27% of beneficiaries, received a general BHI or CoCM service, and 99484 was the most used code (CMS report to Congress, 2024). CMS says integrating behavioral health with primary care leads to improvements, “including reduced depression severity” (CY 2026 PFS fact sheet). 

For an NP or PA practice, that means you can: 

• Keep more patients in your care, with structured follow-up between visits. 

• Refer with judgment, not by default, because measured progress shows who truly needs specialty care. 

• Add a defined service line that gives the mental health care you already provide a team, a workflow and a way to measure it. 

Prescribing authority comes from your license and your state’s rules, not from a billing code or a certificate, so check your state board before you expand your services. 

Build the clinical and practice side with the Integrative Psychiatric Mental Health Certification 

Elite NP’s Integrative Psychiatric Mental Health Certification is for NPs and PAs who already treat psychiatric conditions and want to run integrated care well, and for practice owners and PMHNPs building a psychiatric service. 

• How to Open a Psychiatric Practice: practice models, regulations and liability, EMR and telepsychiatry, staffing, coding, billing, documentation and clinic policies. 

• Clinical Psychiatry for APPs: psychiatric evaluation, prescribing for depression, anxiety, ADHD, sleep and substance use, suicide assessment and documentation. 

• Advanced Psychiatry 2.0: treatment-resistant depression, bipolar disorder, psychosis and high-monitoring medicines such as lithium and clozapine. 

• 14 courses, case studies and a final exam, leading to the title EliteNP Integrative Psychiatric Mental Health Certified Provider. 

• Online and self-paced, with CE from The Elite Nurse Practitioner, accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. 

Program details can change; check the certification page for the current curriculum. It’s a professional certification from Elite NP, not a board certification or a PMHNP program, and it doesn’t change your license or scope of practice. 

Explore the Integrative Psychiatric Mental Health Certification → 

Frequently asked questions about 99484 and collaborative care 

What is CPT 99484? 

CPT 99484 is the code for general behavioral health integration: at least 20 minutes per calendar month of care management for a mental or behavioral health condition, directed by a physician, NP, PA or other eligible practitioner. It requires documented patient consent. 

What is the difference between 99484 and 99492? 

99484 is general BHI, with a 20-minute monthly minimum and no required psychiatric consultant. 99492 is the first month of collaborative care, which requires a care manager, a psychiatric consultant, a registry, weekly caseload review and 70 minutes of care manager time. You can’t bill both for one patient in the same month. 

Can nurse practitioners bill collaborative care codes? 

Yes. CMS names nurse practitioners and physician assistants as treating (billing) practitioners for CoCM codes 99492 to 99494 and G2214. State law and scope of practice still apply to the care team, so check your state board and each payer’s policy. 

What is the collaborative care model? 

The psychiatric Collaborative Care Model (CoCM) is team-based mental health care in primary care. The treating practitioner leads, a behavioral health care manager tracks patients in a registry with validated rating scales, and a psychiatric consultant reviews the caseload weekly and recommends treatment changes. 

Do I need a psychiatric consultant for 99484? 

No. CMS lets general BHI cover care models without a psychiatric consultant or care manager, although they may take part. You can deliver 99484 yourself or through clinical staff. Only the collaborative care codes require a psychiatric consultant. 

Bill for integrated mental health care with the skills to back it up 

CPT 99484 pays for at least 20 minutes of monthly care management; the collaborative care codes pay for a three-person team with a registry and weekly psychiatric review. Get the consent, the initiating visit and the time log right, and recheck the rules against CMS every year. Then make sure your clinical judgment matches the claim. The Integrative Psychiatric Mental Health Certification gives you the full pathway, from psychiatric prescribing to running a psychiatric practice. Starting with operations? The How to Start a Psychiatric Clinic Course covers setup, coding and billing, and Clinical Psychiatry for the NP builds the prescribing foundation. Esketamine practice? See our Spravato billing codes guide. 

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Summarizes Medicare rules in CMS publications current on October 14, 2026; not coding or legal advice. Confirm codes with your Medicare Administrative Contractor, each payer and a certified coder.