Reimbursement
$54.44
Threshold
20m
2026 Status
Active
What is CPT Code 99484?
CPT 99484 is defined as: Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month. Includes assessment, standardized rating scales, care plan revision, and coordination of treatments.
This code is primarily used for BHI services. It falls under the category of Behavioral Health Integration (BHI) and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.93
Physician Effort
PE (Non-Fac)
0.66
Practice Expense
Malpractice
0.04
Risk Factor
Total RVU
1.63
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (Behavioral Health care management service).
primary care revenue
General BHI ($57.45) provides a low-barrier path for PCPs to capture the cost of behavioral health outreach without the full CoCM team requirements.
2026 gpcm3 alignment
Work RVU has been specifically aligned with CMS 2026 crosswalk values for psychiatric integration.
Administrative Framework
Operational Requirements
minimum time
20 minutes of clinical staff time per calendar month.
assessment
Must use validated standardized rating scales (e.g., PHQ-9, GAD-7).
supervision
General supervision by Physician/QHP.
billing unit
Once per calendar month.
Compliance Checklist
Audit Defense
scoring omission
Audit failure risk is high if no PHQ-9 score is recorded to prove 'systematic tracking'.
distinct service
Cannot be billed alongside Psychotherapy codes if the time overlaps.
2026 Update
General BHI is becoming a high-audit area. Documentation must show active treatment coordination, not just 'checking in'.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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