What do doctors typically charge for Care Management Services for Behavioral Health Conditions?

The nationwide median physician charge for Care Management Services for Behavioral Health Conditions (CPT 99484) is $95.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 99484?

The standard insurance baseline reimbursement rate is $37.84. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Care Management Services for Behavioral Health Conditions

CPT 99484Medical Service

Care Management Services for Behavioral Health Conditions

Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional. Clinical pricing breakdown and utilization metrics across 845 practicing doctors nationwide.

$95.00

Peer Median Charge

Gross billed rate

$37.84

Standard Baseline

Customary allowable

2.5x

National Markup

Charge vs baseline

845

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $95.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $37.84 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 99484 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"