Collaborative Care (CoCM) is billed by time, in calendar-month buckets. You report an initial-month code (99492) the first month a patient is enrolled, a subsequent-month code (99493) in later months, and an add-on (99494) for each extra block of time. Each code has a minute threshold you must cross to bill it.

CoCM is one of the few areas of medicine paid this way. There is no per-visit charge. Instead, you total the qualifying minutes a care team spends on a patient during a calendar month, and the total decides which code — if any — you can bill. That makes minute tracking the core operational discipline of a CoCM program, and the place most revenue is won or lost.

How is CoCM billed each month?

CoCM uses monthly time codes rather than visit codes. The three core CPT codes are:

• 99492 — initial month. Reported for the first calendar month a patient receives CoCM, covering the first block of care-management time that month.
• 99493 — subsequent month. Reported for each later month the patient stays enrolled, covering the first block of time that month.
• 99494 — add-on. Reported once for each additional block of time in a month, on top of 99492 or 99493, when the team spends significantly more than the base code's time.

Medicare also recognizes a shorter-threshold code (G2214) for months with a smaller amount of time. Because code definitions and reimbursement change, treat the details below as the general structure and confirm current CMS and CPT values before you bill.

What are the minute thresholds?

Each code is defined by a target amount of time in the calendar month:

• 99492 is described as roughly 70 minutes of initial-month care-management time.
• 99493 is described as roughly 60 minutes of subsequent-month time.
• 99494 covers each additional ~30 minutes beyond the base code's time.

Time-based codes follow a "more than half" convention: you generally can report a code once the team has passed the midpoint of its defined time, not only when it hits the full number. So a month usually becomes billable somewhat before the full 70 or 60 minutes, and the add-on becomes reportable once you're meaningfully into the next 30-minute block. The exact minimums are set by CMS and CPT and are the numbers to verify against current guidance — don't hard-code them from memory.

The practical takeaway: a month either clears its threshold and bills, or it doesn't. There is no partial credit for a month that falls a few minutes short. That cliff is why contemporaneous minute capture matters so much.

What counts as billable time?

Billable CoCM time is the combined time the behavioral health care manager and the psychiatric consultant spend on that patient's care during the calendar month. Most of it is not face-to-face with the patient. Qualifying activities generally include:

• Outreach, engagement, and check-ins with the patient
• Administering and reviewing validated measures (for example, PHQ-9 for depression and GAD-7 for anxiety)
• Care planning and brief evidence-based interventions
• Maintaining the patient registry and tracking whether symptoms are improving
• Regular caseload review between the care manager and the psychiatric consultant
• Coordinating with the treating primary care provider and connecting the patient to resources

Time is totaled per patient, per calendar month, across the whole team — not per encounter. The patient does not need to be present for the time to count, and phone and registry work count. Time spent by the primary care provider on their own evaluation-and-management services is billed separately and is not part of the CoCM minute total.

Why do the calendar-month rules matter?

CoCM time does not carry over. Each calendar month starts a fresh count, and unused minutes from one month cannot be added to the next to push a short month over its threshold. This has a few consequences worth building your workflow around:

• Initial vs. subsequent is a one-time switch. 99492 is used only for the first month of an episode; every later month uses 99493. Billing the wrong one is a common coding error.
• A month is a self-contained unit. Front-load engagement early in the month so a patient who becomes hard to reach later still has enough logged time to bill.
• The add-on is per month, too. 99494 reflects extra time within a single month; it resets like everything else.

Where does CoCM revenue leak?

Most CoCM leakage is not clinical — it's measurement and workflow. The recurring culprits:

• No contemporaneous time capture. If minutes are reconstructed from memory at month-end, months quietly fall short of threshold and become unbillable. Log time as work happens.
• Aggregating per-encounter instead of per-month. Teams undercount because they think of a single call rather than the month's full total across the care manager and psychiatric consultant.
• Dropping the psychiatric consultant's time. Their caseload-review minutes are part of the total; leaving them out can be the difference between clearing a threshold and missing it.
• Missing the 99494 add-on. High-touch months earn extra time that goes unbilled when no one checks whether a second block was reached.
• Coding the wrong base code. Using 99493 in month one, or 99492 in a later month, triggers denials and rework.
• Weak documentation. No validated measure on file, or no registry evidence of tracking, invites payer pushback even when the time was real.

The fix is operational: a live registry, a running per-patient minute tally that includes every team member, and a month-end check that confirms each patient hit the right code — and captured the add-on when earned.

Frequently asked questions

What is the difference between 99492 and 99493?

99492 is the initial-month CoCM code, used only for the first calendar month a patient is enrolled. 99493 is the subsequent-month code, used for every month after that. Both cover the first block of care-management time in their month; the difference is simply first month versus later months.

When can I add 99494?

99494 is an add-on for each additional block of roughly 30 minutes beyond the time already covered by 99492 or 99493 in the same calendar month. You report it only alongside a base code, and only once you've passed the threshold for that extra block. Confirm the current minute minimum with CMS guidance.

Does the time have to be face-to-face with the patient?

No. Most CoCM time is not face-to-face — it includes registry work, symptom tracking, care planning, and the care manager's caseload review with the psychiatric consultant. The patient does not need to be present for the time to count toward the monthly total.

What happens if a patient's minutes fall short in a given month?

That month generally can't be billed with the CoCM time codes, since the codes require crossing a threshold. Medicare's shorter-threshold code (G2214) may fit some lower-time months. The time does not roll into the next month, so front-loading engagement early in the month helps.

Do these thresholds ever change?

Yes. CMS and CPT set and periodically revise the codes, time definitions, and reimbursement. Use the structure here as general guidance and verify the current-year values and rules before billing.