How much does Medicare pay for CPT 99492?

Medicare allowed an average of $146.82 per service and paid $115.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $355.04, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99492?

Initial psychiatric collaborative care management, first calendar month, first 70 minutes. It was billed 22,291 times to 21,531 Medicare beneficiaries by 258 providers in 2024.

Does 99492 pay differently in an office than a hospital?

Yes. The allowed amount averaged $149.37 in an office setting and $88.99 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99492 most?

Nurse Practitioner, with 6,144 services from 103 clinicians. Next are Physician Assistant, Emergency Medicine, Internal Medicine.

CPT 99492

Initial psychiatric collaborative care management, first calendar month, first 70 minutes

$146.82Medicare-allowed amount per service, averaged across 22,291 services

Providers submitted

$355.04

Asking price, not received

Medicare allowed

$146.82

The fee schedule figure

Medicare paid

$115.27

Balance is patient coinsurance

Providers submitted an average of $355.04 for this code and Medicare allowed $146.82 — 2.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $115.27 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $149.37
Hospital / facility: $88.99

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 21,350 services were billed in an office setting and 941 in a facility.

Services: 22,291
Beneficiaries: 21,531
Providers billing it: 258
Total allowed: $3,272,765

What Medicare pays for CPT 99492

Across 22,291 services billed by 258 providers to 21,531 beneficiaries, Medicare allowed an average of $146.82 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99492

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	6,144	6,021	$128.88	103
Physician Assistant	5,188	5,110	$131.93	27
Emergency Medicine	4,874	4,871	$184.34	5
Internal Medicine	2,763	2,682	$144.15	48
Family Practice	1,306	1,264	$150.35	31
Radiation Oncology	527	451	$148.84	1
Physical Medicine and Rehabilitation	417	80	$167.03	3
Psychiatry	338	324	$132.84	6
Interventional Pain Management	159	158	$144.99	4
Cardiology	135	134	$162.29	7
Interventional Cardiology	129	129	$163.18	9
Anesthesiology	65	65	$133.94	4
Geriatric Medicine	63	61	$171.55	2
Psychologist, Clinical	50	50	$97.77	1
Licensed Clinical Social Worker	36	35	$106.75	2

99492 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	6,500	$143.73	$107.14	20
Indiana	3,669	$188.69	$119.65	2
Florida	2,809	$128.71	$101.25	37
Virginia	1,330	$127.12	$100.08	11
California	1,141	$152.90	$107.98	23
Georgia	981	$130.22	$100.38	8
Texas	886	$139.87	$87.81	11
Pennsylvania	806	$133.36	$103.13	8
Michigan	650	$147.78	$117.42	7
Rhode Island	530	$134.11	$101.81	1
Maryland	509	$146.34	$106.19	16
Arizona	502	$140.53	$109.71	29
Minnesota	387	$133.67	$106.68	21
New Jersey	324	$151.34	$113.95	7
Wisconsin	305	$124.27	$102.22	15
Massachusetts	164	$150.10	$108.13	11
North Carolina	156	$135.80	$102.47	2
Colorado	112	$127.24	$97.33	8
Oklahoma	87	$119.45	$101.94	1
Hawaii	80	$156.48	$120.35	2
Illinois	65	$130.92	$101.00	3
Kentucky	61	$143.63	$118.25	1
Louisiana	25	$104.93	$83.08	1
Nebraska	23	$140.96	$115.50	1
Vermont	22	$145.68	$102.04	1
New Mexico	22	$121.96	$95.62	2
South Carolina	22	$121.63	$101.28	1
Washington	18	$171.01	$119.72	1
Ohio	18	$124.61	$95.97	1
District of Columbia	17	$135.54	$101.84	1
Connecticut	17	$147.97	$120.04	1
Tennessee	16	$146.36	$112.59	1
Utah	13	$144.21	$107.19	1
Missouri	13	$73.59	$61.35	1
Oregon	11	$110.89	$89.90	1

Related codes

99490Chronic care management services$59.70
99439Chronic care management services for two or more chronic conditions$46.13
99497Advance care planning$73.95
99457Management using the results of remote vital sign monitoring per calen$48.61
99458Management using the results of remote vital sign monitoring per calen$39.11
99454Remote monitoring of physiologic parameters$47.97
99489Complex chronic care management services for two or more chronic condi$67.00
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99487Complex chronic care management services for two or more chronic condi$124.70
99496Transitional care management services for problem of high complexity$252.87
99426Principal care management services for a single high-risk disease$60.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.