Reimbursement
$60.12
Threshold
30m
2026 Status
Active
What is CPT Code 99494?
CPT 99494 is defined as: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure).
This code is primarily used for BHI services. It falls under the category of Behavioral Health Integration (CoCM) 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
0.9
Physician Effort
PE (Non-Fac)
0.85
Practice Expense
Malpractice
0.05
Risk Factor
Total RVU
1.8
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 service).
revenue capture
99494 ($73.48) ensures specialized mental health teams are compensated for the extra effort required by the most severe behavioral cases.
Administrative Framework
Operational Requirements
minimum time
Each additional 30 minutes beyond the base code (starts at 100 mins in month 1, or 90 mins in sub months).
primary code
99492 (Initial Month) OR 99493 (Subsequent Months).
staff type
Behavioral Health Care Manager time.
stacking rule
Multiple units allowed for each 30-minute block.
Compliance Checklist
Audit Defense
base code dependency
99494 cannot be billed alone. Audit will fail if 99492/99493 is not present.
consultant involvement
Extra time should reflect some level of communication or direction from the psychiatric consultant.
2026 Update
A common audit failure is 'clumping' all mental health time into 99494 without showing specific distinct interventions.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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