How to start a Collaborative Care (CoCM) program in primary care
Collaborative Care is a model in which a primary care provider, a behavioral health care manager and a psychiatric consultant work together to treat common conditions like depression and anxiety, using a registry to track every patient. Medicare and many other payers pay for it with monthly codes.
Who is on the Collaborative Care team?
- Treating provider: the primary care clinician who bills and directs care
- Behavioral health care manager: follows each patient, tracks symptoms and provides brief interventions
- Psychiatric consultant: reviews the caseload, usually weekly, and recommends treatment changes
The care manager does most of the day-to-day work and their time drives billing.
What registry does Collaborative Care need?
A registry is a list of every enrolled patient with their symptom scores, last contact and next steps. It lets the team see who is improving and who is not. It can be a dedicated tool or a well-built spreadsheet, as long as it is used every week.
Which codes are used for Collaborative Care?
For minute thresholds and example months, see 99492, 99493, 99494 and G2214: time thresholds with examples.
- 99492: first month, first 70 minutes of care manager time
- 99493: later months, first 60 minutes
- 99494: each additional 30 minutes, added to 99492 or 99493
- G2214: 30 minutes in a month, for lower-time months
As of early 2026, the approximate Medicare national average for 99492 was around $163. Medicaid coverage varies by state, and several states added it recently.
What do you need before you bill Collaborative Care?
- Patient consent to participate, including that cost sharing may apply
- A trained care manager and an arrangement with a psychiatric consultant
- The registry and a weekly caseload review
- Time tracking for care manager minutes
- A measurement tool such as the PHQ-9 for depression or GAD-7 for anxiety
How do you implement Collaborative Care in the first 90 days?
- Weeks 1 to 2: pick the condition you will start with and confirm payer coverage.
- Weeks 2 to 4: hire or contract the care manager and psychiatric consultant; set up the registry.
- Weeks 4 to 6: train front desk and providers on how to identify and refer patients.
- Weeks 6 to 8: enroll the first patients and hold the first caseload review.
- Weeks 8 to 12: submit first claims, check payments and fix documentation gaps.
What common mistakes slow Collaborative Care launches?
- Counting the wrong minutes toward thresholds
- Skipping the weekly caseload review
- Enrolling patients without documented consent
- Letting the registry go stale
- Not telling patients about possible cost sharing
When is CoCM a better fit than BHI?
A fuller comparison is in CoCM vs BHI vs Advanced Primary Care codes: which fit your practice.
General behavioral health integration (99484) has fewer requirements and lower payment. CoCM requires the full team and registry but pays more and has stronger evidence behind it.
Frequently asked questions
Does the psychiatric consultant need to see patients?
No. The consultant usually advises the team without seeing patients directly.
Can the care manager be remote?
Often yes, as long as they are part of the care team and meet payer rules.
How many patients can one care manager follow?
It depends on intensity, but many programs plan for a caseload in the dozens.
Sources and check date
Time thresholds and code names above follow the public CPT descriptions for 99492, 99493, 99494 and G2214. Medicare payment figures are approximate national averages from early 2026 and vary by locality and year. Confirm current payer rules before you bill. Checked against public CMS materials as of October 11, 2026. Primary sources: the CMS Behavioral Health Integration Services booklet (MLN909432) and the CMS Care Management overview.
Related Triad guides
- 99492, 99493, 99494 and G2214: time thresholds with examples
- CoCM vs BHI vs Advanced Primary Care codes: which fit your practice
How Triad helps
Triad provides the care manager, psychiatric consultant and registry so primary care practices can offer Collaborative Care without hiring a new team. See if CoCM fits your practice.