Staffing the Collaborative Care Model: Care Manager, Psychiatric Consultant, Billing Provider

Collaborative Care (CoCM) is a team-based behavioral health service that Medicare pays for inside medical practices: a treating practitioner manages patients' behavioral health conditions with psychiatric backup, and a care manager keeps each patient moving between visits.

In CMS's Behavioral Health Integration Services booklet (MLN909432, January 2026), the service is delivered by a team of three — a behavioral health care manager, a psychiatric consultant and the treating (billing) practitioner.

The treating practitioner is typically a primary care clinician, but CMS notes the role can sit in other specialties and names cardiology and oncology as examples.

The model has a defined arc.

It starts with consent: before services begin, the patient must agree to BHI — verbal consent documented in the record is enough — and be told that cost sharing applies.

It ends when CMS says it ends: the patient meets treatment goals, fails to meet them and is referred for direct psychiatric care, or goes six consecutive months with no CoCM.

For staffing, that last condition matters — the registry is a roster of active episodes, not a permanent subscription.

This page is about the staffing consequences: who the three roles are, what qualifications CMS actually attaches to each, and how the per-patient minutes behind the CoCM codes tell you how many people to hire.

CMS's booklet is specific about who does what.

Here is the team it describes, with the hiring note for each seat.

Two structural rules shape every hiring decision in the model.

First, care team members must be employees of, or working under contract with, the billing practitioner, and their services are furnished incident to the billing practitioner's services, subject to state law and scope of practice — our guide to incident-to billing explains how that arrangement works.

Second, Medicare assigns BHI services the billing practitioner does not personally perform to general supervision, which does not require the practitioner's physical presence.

The care manager can work with patients when the practitioner is not in the building.

Start with what CMS does not require: a specific license.

The booklet's definition asks for a designated provider with formal education or specialized training in behavioral health, naming social work, nursing and psychology as included fields — it names no license and no degree level.

Whatever the hire's credentials, state scope-of-practice law still governs what they may actually do, so map the duty list against your own state's rules before you write the posting.

For a picture of who actually holds the job, the University of Washington AIMS Center — the academic program that developed the model — says behavioral health care managers are typically clinical social workers, licensed counselors, nurses or psychologists, and adds that in some contexts the care manager may not be licensed.

AIMS also makes the hiring point bluntly: the ability to perform, assign and plan the work matters more than the credentials one holds.

That is program guidance, not Medicare rule — but it is the guidance the model grew up with.

Write the job description around CMS's duty list, because those duties are what the minutes pay for: administering validated rating scales, building and revising care plans, delivering brief psychosocial interventions, maintaining the patient registry, and consulting the psychiatric consultant.

Around the task list sit three availability expectations: a continuous relationship with the patient, the ability to see patients face-to-face, and the ability to work outside regular clinic hours as necessary.

That last one is a scheduling decision, not a slogan — build it into the posted schedule and the pay discussion.

Two notes from CMS's fine print.

The care manager may or may not be a practitioner who can independently bill Medicare, so a clinician who cannot bill in their own name can still hold the role.

And the time that counts toward CoCM minutes is care-manager time: administrative and clerical staff do not qualify, so this is a clinical hire, not a gap filled from the front desk.

When you are ready to source candidates, our role guide to hiring a case manager covers the market, screening and pay context for this corner of behavioral health.

CMS's definition is a medical provider trained in psychiatry and qualified to prescribe the full range of medications.

Two design features follow from the rest of the booklet: the consultant can — and typically will — be remotely located, and is not generally expected to see patients directly, prescribe, or deliver other treatment to the patient.

Prescribing generally stays with the treating practitioner; the consultant's job is advice.

The AIMS Center describes the cadence: the consultant joins the care manager for caseload reviews and recommends treatment changes when a patient is not at least 50% improved after 10 to 12 weeks on a treatment plan.

The weekly review is not optional color — CMS requires the care manager and psychiatric consultant to conduct regular caseload reviews weekly.

On volume, AIMS estimates 2 to 3 hours per week of psychiatric consultant time for each full-time or nearly full-time care manager managing a full caseload, including the systematic caseload review.

That estimate is the whole business case for the contracted model: you are buying a few hours a week of psychiatric time, not a line on the daily schedule.

CMS's employment rule allows either shape: care team members may be employees of, or under contract with, the billing practitioner.

An employed consultant is simplest for scheduling and availability, but pays for far more availability than 2 to 3 hours a week uses.

A contracted consultant matches the shape of the work — AIMS describes a consultant who does not normally see patients and may be available during business hours for ad-hoc consultation, which is a service level you can write into a contract.

Whichever way you go, put the weekly review, the response expectations and registry access in writing before the first patient enrolls.

CoCM is paid against care-manager minutes, and the thresholds are your staffing arithmetic.

CMS requires at least 70 minutes of behavioral health care manager time in the first month of an episode and at least 60 minutes in each following month, with weekly caseload reviews between the care manager and the psychiatric consultant throughout.

The codes parcel those minutes:

• CPT 99492 — the first 70 minutes of care manager activity in the first calendar month.
• CPT 99493 — the first 60 minutes in a subsequent month.
• CPT 99494 — each additional 30 minutes.
• HCPCS G2214 — the first 30 minutes in a month.

The billing practitioner is not a bystander in the time math.

CMS's coding table assumes 30 minutes of billing-practitioner time for 99492, 26 minutes for 99493 and 13 minutes for 99494 — budget for that time when you set the practitioner's schedule, or the model will quietly cannibalize visit slots.

A lighter alternative exists.

General BHI (CPT 99484) requires at least 20 minutes of clinical staff time per month and requires neither a psychiatric consultant nor a care manager — and Medicare bars reporting general BHI codes in the same month as CoCM codes for the same patient.

There is also a dedicated code for psychology- and social-work-led programs: HCPCS G0323 lets a clinical psychologist or clinical social worker bill at least 20 minutes per month of behavioral health care management, with a psychiatric diagnostic evaluation (90791) as the initiating visit.

If your minutes projection says your population does not need the full three-person team, one of these is the honest staffing answer.

One 2026 change belongs in your billing setup rather than your org chart: from January 1, 2026, CMS added optional add-on codes — G0568 and G0569 for CoCM, G0570 for general BHI — for patients also receiving advanced primary care management (APCM).

They are not time-based, so they change claims, not headcount.

Deliberately absent from this page: dollar figures.

Medicare payment amounts for the CoCM codes should be pulled from CMS's current Physician Fee Schedule for your locality when you build the budget — a staffing model built on a stale reimbursement figure is wrong before it starts.

A workable sequence, starting from an existing medical staff: confirm the billing practitioner, hire the care manager, then line up the consultant relationship.

The ordering is about calendar and cash — the care manager's registry takes time to fill, while a contracted consultant can start with a single standing meeting.

Hire the care manager at full-time or nearly full-time from the start.

That is the AIMS Center's recommendation, and it has evidence behind it: AIMS cites a study (Moise et al., 2018) in which clinics with a 0.5 FTE care manager were less likely to sustain their Collaborative Care programs than clinics with care managers at higher FTEs.

AIMS also notes a single care manager may need to cover two or more small clinics — relevant if you run multiple sites.

On caseload, CMS sets minutes per patient and no ceiling — the ceiling is arithmetic, not regulation.

The AIMS Center's illustrations sketch 80 patients for a full-time care manager working partly virtually with common adult depression and anxiety or a commercially insured population, and 60 for more complex, pediatric or geriatric, or Medicaid- and uninsured-serving FQHC populations.

Those are illustrations, not standards.

The assumptions behind them matter more than the numbers: AIMS builds both figures on a care manager spending 75% of their time on direct care, which leaves 130 hours a month for appointments.

Run your own version of that math — your direct-care share, your population — instead of importing someone else's caseload.

Leave slack.

AIMS warns that a caseload that is too high can hurt staff morale and retention — and it is the care manager who holds the program's continuous patient relationships.

When the registry outruns the minutes, the fix is a second hire — the behavioral health hiring hub collects the employer guides for everything that comes next, from screening to pay models.