CPT 99492 Fee Schedule
Last Updated: April 2025
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 (Desc Rvsd 1/1/22)
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Psychiatric Collaborative Care Management Services |
| Common Place of Service | • 11 - Office • None • None |
| Common Modifiers | • None • 25 - Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service • GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Moderate |
National average reimbursement for CPT 99492 by major payers:
$166.40
$195.83
$165.04
$254.24
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.
CPT 99492 vs. 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 99202 | Low | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
| 99484 | Low | 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 Withthe 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 (Desc Rvsd 1/1/22) |
| 99487 | Low | 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 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 | Moderate | 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 (Desc Rvsd 1/1/22) |
See what providers are getting paid in 2024 for 99492:
CPT 99492 Fee Schedule & Reimbursement Rates
The CPT 99492 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 99202 | $72.23 | $109.17 | |
| 99484 | $54.92 | $87.87 | |
| 99487 | $134.15 | $190.20 | |
| 99492 | $153.12 | $254.24 | |
| 99493 | $139.81 | $222.46 | |
| 99494 | $59.25 | $107.51 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
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