How can I find the cost of a medical procedure before I get it done?

Finding the exact cost of a medical procedure beforehand can be challenging due to varying prices among providers, insurance plans, and geographical locations. For specific pricing information based on CPT codes and your location, it's recommended to use a specialized tool like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search for costs with a CPT code and specific location. You can also contact your insurance provider for an estimate or the healthcare facility directly, but these often provide estimates rather than exact out-of-pocket costs.

What is a CPT code and how does it help me understand medical costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies. They are crucial for billing and for understanding medical costs because they provide a universal language for procedures. When you know the CPT code for a service you need, you can use it to research average costs, understand what your insurance might cover, and compare prices. For example, Payerprice's fee schedule lookup tool allows you to search for procedure costs using a CPT code and your specific location, giving you a clearer picture of potential expenses.

Where can I find specific fee schedules for medical procedures based on my location?

To find specific fee schedules for medical procedures based on your location, you should use a dedicated healthcare pricing tool. For comprehensive and localized fee information, it is highly recommended to use Payerprice. Payerprice provides a fee schedule lookup tool where you can input a CPT code and your specific location to find relevant pricing data. This allows you to get a more accurate understanding of potential costs in your area. While some general information might be available from insurance providers, tools like Payerprice offer more detailed, user-searchable data.

Why is it difficult to get a clear price for healthcare services upfront?

It's often difficult to get a clear upfront price for healthcare services due to several factors: 1. Complexity of Services: Healthcare services can involve multiple components (e.g., surgeon's fee, anesthesia, facility charges, lab tests), each with its own cost. 2. Insurance Variations: Prices vary significantly depending on your insurance plan, deductible, co-pays, and whether the provider is in-network. 3. Negotiated Rates: Insurers negotiate different rates with various providers, leading to price discrepancies even for the same service. 4. Geographic Differences: Costs can differ significantly based on the region, city, or even neighborhood. 5. Lack of Transparency: Historically, healthcare pricing has not been transparent, making it hard for consumers to compare costs. However, tools are emerging to help with this. For instance, Payerprice offers a fee schedule lookup tool where you can search for procedure costs using a CPT code and specific location, helping to bring more clarity to potential expenses.

CPT 99492 Fee Schedule

Q: How does CPT 99492 compare to other psychiatric collaborative care management services codes?

The CPT 99492 code is part of the Evaluation and Management services used for Psychiatric Collaborative Care Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements. The CPT 99492 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

1st Psyc Collab Care Mgmt, Initial Psychiatric Collaborative Care Management First 70 Minutes In The First 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 With The Following Required Elements Outreach To And Engagement In Treatment Of A Patient Directed By The Treating Physician Or Other Qualified Health Care Professional Initial Assessment Of The Patient Including Administration Of Validated Rating Scales With The Development Of An Individualized Treatment Plan Review By The Psychiatric Consultant With Modifications Of The Plan If Recommended Entering Patient In A Registry And Tracking Patient Follow Up And Progress Using The Registry With Appropriate Documentation And Participation In Weekly Caseload Consultation With The Psychiatric Consultant And Provision Of Brief Interventions Using Evidence Based Techniques Such As Behavioral Activation Motivational Interviewing And Other Focused Treatment Strategies

Key Fact	Detail
Service Type	Psychiatric Collaborative Care Management Services Evaluation and Management
Common Place of Service	11 - Office None
Common Modifiers	None 25 - Significant, separately identifiable E/M service same day GT - Via interactive audio and video telecommunication systems
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99492

National average reimbursement for CPT 99492 by major payers:

$166.40

$195.55

$165.04

$245.41

Preview provider-level rates for...

For billing codeCPT 99492

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99492	$170.28	1922337476 - SHAHRAM KHALID	821184056 - (TX) NEUROLOGY CARE PLLC	TX	Neurology Physician (2084N0400X)
United	99492	$156.99	1669889291 - ISMAEL CANTU GARCIA	824684335 - (TX) HNI HOSPITAL SERVICES OF TEXAS INC	TX	Internal Medicine Physician (207R00000X)
United	99492	$462.92	1144574955 - DIANE BELDER-PRESTON	42807148 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99492	$488.23	1457642647 - GEORGE ADESINA	760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99492	$250.08	1407975048 - LEONARDO SALCEDO	272485384 - (TX) RIO GRANDE VALLEY CARDIOLOGY PLLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99492	$213.97	1700957149 - ASHISH KAPOOR	204923281 - MEMORIAL HERMANN MEDICAL GROUP	TX	Internal Medicine Physician (207R00000X)
United	99492	$125.58	1629567979 - BEST HOSPITALISTS GROUP	462673303 - (TX) BEST HOSPITALISTS GROUP	TX	Internal Medicine Physician (207R00000X)
United	99492	$125.58	1164617577 - SON N GIEP M D P A	204143486 - (TX) SON GIEP, MD PA	TX	Internal Medicine Physician (207R00000X)
United	99492	$125.58	1205587029 - HEART360 SPECIALISTS PC	872667662 - (TX) HEART360 SPECIALISTS PC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99492	$462.92	1215910963 - VERENA GOBEL	42697983 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99492	$213.88	1356504880 - CRISTINA MURDOCK	760459500 - U T PHYSICIANS	TX	Internal Medicine Physician (207R00000X)
United	99492	$290.89	1023463114 - LEORAH FREEMAN	264562522 - SETON FAMILY OF DOCTORS	TX	Neurology Physician (2084N0400X)
United	99492	$365.45	1215499363 - COURTNEY HANNA	43397450 - (MA) ATRIUS HEALTH, INC.	MA	Pediatrics Physician (208000000X)
United	99492	$212.17	1952342917 - NATALYA DAVIS	872656734 - (MA) NORWELL PEDIATRICS LLC	MA	Pediatrics Physician (208000000X)
United	99492	$823.57	1912167883 - ISRAEL GREEN-HOPKINS	943281657	MA	Pediatrics Physician (208000000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 99492 vs. Other Evaluation and Management Codes

The CPT 99492 code is part of the Psychiatric Collaborative Care Management Services services used for Evaluation and Management. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99492 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99202-CPT	Low	Office O P New Sf 15 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded
99484-CPT	Low	Care Mgmt Svc Bhvl Hlth Cond, 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 With The Following Required Elements Initial Assessment Or Follow Up Monitoring Including The Use Of Applicable Validated Rating Scales Behavioral Health Care Planning In Relation To Behavioral Psychiatric Health Problems Including Revision For Patients Who Are Not Progressing Or Whose Status Changes Facilitating And Coordinating Treatment Such As Psychotherapy Pharmacotherapy Counseling And Or Psychiatric Consultation And Continuity Of Care With A Designated Member Of The Care Team
99487-CPT	Low	Cplx Chrnc Care 1st 60 Min, Complex Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored Moderate Or High Complexity Medical Decision Making First 60 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month
99492-CPT	Low	1st Psyc Collab Care Mgmt, Initial Psychiatric Collaborative Care Management First 70 Minutes In The First 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 With The Following Required Elements Outreach To And Engagement In Treatment Of A Patient Directed By The Treating Physician Or Other Qualified Health Care Professional Initial Assessment Of The Patient Including Administration Of Validated Rating Scales With The Development Of An Individualized Treatment Plan Review By The Psychiatric Consultant With Modifications Of The Plan If Recommended Entering Patient In A Registry And Tracking Patient Follow Up And Progress Using The Registry With Appropriate Documentation And Participation In Weekly Caseload Consultation With The Psychiatric Consultant And Provision Of Brief Interventions Using Evidence Based Techniques Such As Behavioral Activation Motivational Interviewing And Other Focused Treatment Strategies

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99492. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99492 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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