Is Collaborative Care Worth It for a Behavioral Health Practice?

Collaborative care can pay off for a behavioral health practice, but only with steady enrollment and tight time tracking.

Medicare pays collaborative care as a monthly service. For each month a patient is enrolled, the practice bills once the care manager's time reaches the CMS minimum. For CY2026 the national non-facility amount is $160.32 for the first month (99492) and $144.96 for each later month (99493), per the CMS Physician Fee Schedule Look-Up Tool. Those amounts are before geographic adjustment and patient cost sharing.

The money follows volume and minutes. A care manager with a full caseload who logs every qualifying minute can turn these codes into a steady monthly line. A month where the care manager logs too little time for 99492 or 99493 falls back to G2214, which pays much less, or to no code at all.

Next step: before you hire, estimate how many patients you can enroll each month and whether your team can document the monthly minutes CMS lists for each of them. CMS sets no salary or staffing ratio, so that math is yours to run.

In CY2026 Medicare pays $57.45 to $160.32 per code per month at the national non-facility rate.

We took each code's total non-facility RVUs from the CMS RVU26D file and multiplied them by the $33.4009 conversion factor set in the CY2026 PFS final rule. Every amount below matches the PFS Look-Up Tool for 2026 at the national locality.

CMS PFS Look-Up Tool, year 2026, national locality, data updated 10/01/2026. Non-qualifying APM conversion factor. Amounts are before geographic adjustment and patient cost sharing. Clinicians paid under the qualifying APM conversion factor ($33.5675) see slightly higher amounts.

Facility vs non-facility rates

Facility amounts are lower. CMS tells you to report the place of service where the billing practitioner would normally see the patient face to face (MLN909432, p. 12). So a practitioner who normally sees patients in a hospital outpatient department bills at the facility rate even when the care manager works remotely (CMS BHI FAQs, Q11).

Cost sharing applies too. Before services start the billing practitioner has to tell the patient that cost sharing applies to both face-to-face and non-face-to-face services (CMS consent rules).

Next step: confirm your place of service setup before the first claim so each code pays at the rate you planned for.

The treating practitioner bills collaborative care. Psychiatry groups usually fit as the psychiatric consultant or as a general BHI biller, and psychology, social work and counseling practices fit through G0323.

CMS describes the treating practitioner as a physician or NPP who typically works in primary care but may specialize in other fields (MLN909432, p. 5). That practitioner bills 99492, 99493 and 99494. The psychiatric consultant and the care manager can be employees or contractors, and the consultant is commonly remote (CMS BHI FAQs, Q4).

Psychiatry groups: consultant or general BHI biller

A psychiatry group has two routes. It can serve as the psychiatric consultant for a primary care team under contract. Medicare pays the billing practitioner for the service, not the consultant (CMS BHI FAQs, Q8).

Or a psychiatrist can bill general BHI with 99484. CMS generally doesn't expect psychiatrists to bill the collaborative care codes, because psychiatric work is part of those codes (CMS BHI FAQs, Q13). CMS lists psychiatry among the specialties a general BHI treating practitioner can come from (MLN909432, p. 9). If you run psychiatry billing in house, set 99484 up as its own monthly workflow, separate from visit billing.

Psychology, social work and counseling practices: G0323

HCPCS G0323 covers at least 20 minutes of clinical psychologist or clinical social worker time per calendar month (MLN909432, p. 10). Since 2024 its descriptor also covers mental health counselor and marriage and family therapist time, and CMS finalized it so all four can bill it (CY2024 PFS final rule, 88 FR 79000). Its initiating visit is the psychiatric diagnostic evaluation (90791), not an E/M visit.

For therapy and psychology practices this is the BHI code built around their own clinicians' time.

Next step: decide which role fits before you build a workflow. The consultant, the general BHI biller and the G0323 biller each track different time.

Collaborative care needs three roles, a registry, validated rating scales, weekly caseload reviews, an initiating visit and documented consent.

The three roles

• Treating (billing) practitioner: directs the care manager and oversees the patient's care, including prescribing and referrals.
• Behavioral health care manager: has formal education or specialized training in behavioral health, such as social work, nursing or psychology. Medicare sets no minimum education requirement (CMS BHI FAQs, Q5).
• Psychiatric consultant: a medical provider trained in psychiatry and qualified to prescribe the full range of medications (MLN909432, p. 5).

Your staffing cost is mostly the care manager's hours and the consultant's review time. CMS sets no salary, so we don't quote one here.

Registry, rating scales and weekly review

The care manager follows each patient in a registry, uses validated rating scales and meets the psychiatric consultant for a weekly caseload review (MLN909432, p. 6). Patients who aren't improving get their plan revised in that review.

Consent and the initiating visit

BHI starts with an initiating visit by the billing practitioner, such as an annual wellness visit, an initial preventive physical exam, a comprehensive E/M visit or a transitional care management visit (MLN909432, p. 3). CMS requires it for new patients and for patients not seen within a year before BHI starts (CMS BHI FAQs, Q18).

Consent can be verbal, but it has to be documented in the medical record. A new consent is needed only when the patient changes billing practitioners (CMS BHI FAQs, Q16 and Q17).

Next step: build the registry and the consent template first. Every later claim depends on both.

Collaborative care revenue mostly goes unbilled in minutes that never reach the monthly threshold or never get written down.

Tracking minutes to the threshold

CMS lists a threshold of 70 minutes of care manager time for 99492 in the first month and 60 minutes for 99493 in later months, and CPT time rules apply. Each added 30 minutes can be billed with 99494 (BHI coding summary, MLN909432 p. 13). If nobody tracks time past the base threshold, the add-on never gets billed.

When a month falls short, G2214 covers the first 30 minutes. CMS gives the example of a patient you hospitalize or refer for specialized care before the full time is reached (MLN909432, p. 8).

Time spent only on administrative or clerical work doesn't count toward any threshold (MLN909432, p. 11). Once the minimum time is met you can send the claim without holding it to month end (CMS BHI FAQs, Q10).

Same-month rules

You can't bill general BHI and collaborative care for the same patient in the same month, but you can switch between them across months (CMS BHI FAQs, Q3). BHI can be billed in the same month as chronic care management when both have advance consent and time isn't counted twice (BHI FAQ on CCM, Q2).

The APCM add-ons

Since January 1, 2026 three optional add-ons apply when you also bill advanced primary care management in the same month: G0568 and G0569 for collaborative care and G0570 for general BHI. They need an APCM base code (G0556, G0557 or G0558) and aren't time-based (MLN909432, p. 13). CMS finalized them in the CY2026 PFS final rule, 90 FR 49470-49471.

Next step: compare logged minutes with billed codes for your last few months. An audit of unbilled care management time can show where minutes stopped short of a code.

The common collaborative care denial risks are missing consent, a missing initiating visit, weak time records and the wrong code for the month.

Documentation that holds up

• Consent is in the record, including the cost sharing conversation.
• A qualifying initiating visit happened before BHI started, for a new patient or one not seen within a year.
• Care manager minutes are logged by date, with clerical time left out.
• Time is counted once, even when the care manager also bills psychotherapy that month (CMS BHI FAQs, Q7).
• Only general BHI or collaborative care is billed for the patient that month, not both.

A coding review before claims go out checks each of these against the chart.

RHC and FQHC billing changes

As of January 1, 2026 RHCs and FQHCs can no longer be paid for G0512. They now bill the individual CPT and HCPCS codes that make up G0512 (CY2026 PFS final rule, 90 FR 49553).

Next step: run one month of charts against this list before you grow the program.

Billers use six codes for the standalone monthly services: 99492, 99493, 99494 and G2214 for collaborative care, and 99484 and G0323 for general BHI.

CMS notes that CPT time rules apply to general BHI and collaborative care (MLN909432 coding table). The G0323 row follows the current code descriptor, which added mental health counselors and marriage and family therapists (CY2024 PFS final rule).

Next step: keep this table next to your time log so each month lands on the right code.