Summary & Overview
HCPCS G0409: Social Work and Psychological Services, Individual, 15 Minutes
HCPCS Level II code G0409 designates face-to-face social work or psychological services delivered in 15-minute increments by a CORF-qualified social worker or psychologist to support a patient’s rehabilitation goals. This code is used to bill individual behavioral health services provided within a Comprehensive Outpatient Rehabilitation Facility (CORF) and is relevant to care teams coordinating psychosocial and psychological rehabilitation interventions. Nationally, the code matters because it captures discrete, time-based therapeutic activities that contribute to functional recovery and interdisciplinary rehabilitation plans.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and appropriate service settings for G0409, summary benchmarks where available, and notes on common billing considerations and documentation expectations tied to time-based, individual psychotherapy and social work services in CORF settings. The publication provides concise guidance on the code’s purpose, typical utilization scenarios, and the types of outcomes and rehabilitation goals these services support. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0409 covers social work and psychological services that directly relate to and further a patient's rehabilitation goals. The code describes services billed in 15-minute face-to-face increments and applies to individual therapy sessions provided by a CORF-qualified social worker or psychologist in a Comprehensive Outpatient Rehabilitation Facility (CORF) setting.
Service type: Behavioral health rehabilitation support (individual psychotherapy/social work services)
Typical site of service: Comprehensive Outpatient Rehabilitation Facility (CORF), face-to-face sessions
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient undergoing outpatient rehabilitation at a certified outpatient rehabilitation facility (CORF) after a left total knee arthroplasty presents for interdisciplinary care. The CORF team includes a CORF-qualified social worker and a psychologist who provide face-to-face supportive and psychological interventions directly related to the patient’s rehabilitation goals. During a scheduled 15-minute individual session billed under G0409, the social worker assesses coping with postoperative pain, evaluates barriers to home discharge (social support, transportation, financial concerns), provides brief counseling to enhance adherence to the home exercise program, and documents problem-focused interventions that further the patient’s functional goals. The clinical workflow begins with referral from the physical therapist or physiatrist when psychosocial needs are identified, scheduling of the G0409 face-to-face encounter, targeted screening (e.g., brief mood or cognitive screen), delivery of time-based intervention in 15-minute units, documentation of start and stop times, content tied to stated rehabilitation goals, and coding/billing of units of G0409 with applicable modifiers and the primary ICD-10 diagnosis that justifies the rehabilitative need.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |