G0323 Behavioral Health Care Management Reimbursement

HCPCS Level II code G0323 designates structured care management services for patients with behavioral health conditions, requiring at least 20 minutes per calendar month of clinician time by a clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist. The code captures key elements of care management: initial assessment or ongoing monitoring (including validated rating scales), individualized care planning with revisions for nonresponse or status change, facilitation and coordination of psychotherapy and psychiatric consultation, and continuity with a designated care team member. Nationally, G0323 matters as payers and systems increasingly emphasize behavioral health integration, measurement-based care, and care coordination to improve outcomes and reduce avoidable utilization.

This publication covers payer policy and coverage considerations for major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of service components and typical ambulatory service locations, coverage and billing context for these payers, and a summary of common modifiers and operational considerations. The report also provides clinical context on who may furnish the service and how the code is used to document care management workflows. Data not available in the input for associated taxonomies, ICD-10 pairings, related codes, and service-line financial benchmarks are noted where applicable.

Clinical Context

A 42-year-old woman with a history of major depressive disorder and generalized anxiety disorder presents for ongoing behavioral health care management. She is followed by a licensed clinical social worker (LCSW) who provides at least 20 minutes of care management activities during the calendar month: an initial assessment of mood and functioning using validated rating scales (PHQ-9 and GAD-7), revision of the behavioral health care plan after the patient reports worsening sleep and concentration, coordination of care with the patient’s primary care physician and the psychiatrist authorized to prescribe medication, scheduling referral for psychotherapy, and ensuring continuity through a designated care team member who documents follow-up and crisis plan. The service is billed under G0323 for the monthly care management time delivered by a clinical social worker.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When additional time or complexity beyond typical behavioral health care management is documented and justified.
`23`	Unusual anesthesia

Billing Code Overview

HCPCS Level II code G0323 describes care management services for behavioral health conditions requiring at least 20 minutes per calendar month of clinician time provided by a clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist. The service includes an initial assessment or follow-up monitoring (including use of validated rating scales where applicable), behavioral health care planning and revisions for patients not progressing or with status changes, facilitating and coordinating treatment (such as psychotherapy, coordination with or referral to clinicians authorized to prescribe medications and furnish evaluation and management services, counseling, and psychiatric consultation), and continuity of care with a designated member of the care team.

Service type: Behavioral health care management / care coordination

Typical site of service: Outpatient behavioral health settings, community mental health centers, clinics, and other ambulatory care settings where licensed behavioral health clinicians provide care management services

Taxonomy Code	Specialty	Notes
`101Y00000X`	Clinical Psychologist	Provides psychological assessment, validated rating scales, and care planning.
`1041C0700X`	Clinical Social Worker	Frequently delivers monthly behavioral health care management and coordination.
`101YM0800X`	Mental Health Counselor	Provides psychotherapy and care coordination consistent with `G0323` elements.
`103K00000X`	Marriage and Family Therapist	Delivers family-focused behavioral health care planning and follow-up.
`2084N0400X`	Psychiatry & Neurology (Psychiatry)	Coordinates medication management and psychiatric consultation as part of the care team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.1`	Major depressive disorder, single episode, moderate	Common indication for monthly behavioral health care management and treatment planning.
`F33.1`	Major depressive disorder, recurrent, moderate	Ongoing care management supports monitoring, care plan revision, and coordination with prescribers.
`F41.1`	Generalized anxiety disorder	Frequent target of behavioral health care management with validated rating scale monitoring (GAD-7).
`F43.21`	Adjustment disorder with depressed mood	Short-term behavioral health care management for situational stressors and care coordination.
`F41.9`	Anxiety disorder, unspecified	Used when anxiety symptoms drive care management but specific subtype is not coded.
`F90.0`	Attention-deficit hyperactivity disorder, predominantly inattentive type	Behavioral management and coordination with prescribers for medication and psychotherapy.
`F31.3`	Bipolar disorder, current episode depressed, moderate	Requires close monitoring, care planning, and coordination with psychiatric medication management.
`F32.A`	Depression, other specified	Used for depressive presentations that require care management but do not fit standard categories.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (without medical services)	Used before or alongside `G0323` when an initial diagnostic assessment is needed to establish behavioral health diagnoses and baseline measures.
`90832`	Psychotherapy, 30 minutes with patient	Short individual psychotherapy sessions that may be coordinated with monthly care management; psychotherapy visits are commonly scheduled in addition to `G0323`.
`90834`	Psychotherapy, 45 minutes with patient	Standard psychotherapy length that complements ongoing monthly care management and treatment planning.
`99492`	Initial psychiatric collaborative care management, first 70 minutes in the first calendar month	Collaborative care model code used in related integrated behavioral health programs; may be billed in organizations using collaborative care alongside `G0323` depending on payer rules.
`99484`	Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, per calendar month (general behavioral health CCM)	Alternative care management CPT often used for non-Medicare payers or different provider types; clinically related to `G0323` as a monthly behavioral health care management service.

OpenPayer

Summary & Overview

HCPCS G0323: Behavioral Health Care Management, ≥20 Minutes/Month

Clinical & Coding Specifications