Summary & Overview
HCPCS G0507: Behavioral Health Care Management, Monthly
HCPCS Level II code G0507 represents monthly care management services for behavioral health conditions, requiring at least 20 minutes of clinical staff time under clinician direction and including assessment, treatment planning, coordination, and continuity of care. The code addresses a growing national need to integrate behavioral health management into ambulatory and primary care settings, supporting measurement-based care and coordinated treatment across psychotherapy, pharmacotherapy, counseling, and psychiatric consultation. Its structured monthly framework enables practices to document and bill for care coordination and ongoing monitoring for patients with behavioral or psychiatric conditions.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and coverage patterns, coding and billing context, clinical implications for care teams, and summaries of policy updates affecting behavioral health care management services. The publication outlines typical service settings, how the code fits into care delivery models that emphasize continuity and validated symptom measurement, and considerations for integration with broader behavioral health workflows. Data not available in the input is indicated where applicable.
Billing Code Overview
HCPCS Level II code G0507 describes care management services for behavioral health conditions. The code covers at least 20 minutes of clinical staff time per calendar month, directed by a physician or other qualified health care professional, and requires: an initial assessment or follow-up monitoring using applicable validated rating scales; behavioral health care planning and revision when patients are not progressing or their status changes; facilitation and coordination of treatments such as psychotherapy, pharmacotherapy, counseling, and/or psychiatric consultation; and continuity of care with a designated member of the care team.
Service Type: Behavioral health care management
Typical Site of Service: Outpatient behavioral health settings, primary care clinics, or other ambulatory care sites where care coordination and monthly clinical staff time are provided under clinician direction.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a diagnosis of major depressive disorder and generalized anxiety disorder is enrolled in monthly behavioral health care management under code G0507. The patient has had an initial assessment by clinical staff (licensed clinical social worker) that included validated rating scales (PHQ-9, GAD-7). Over the month the care manager documents at least 20 minutes of clinical staff time directed by the treating psychiatrist, provides follow-up monitoring, coordinates psychotherapy sessions and medication management with the prescribing psychiatrist, updates the behavioral health care plan because the patient reports partial response to current antidepressant therapy, and ensures continuity of care by assigning a designated team member for outreach and crisis contact. The workflow includes: referral or enrollment; initial assessment with validated scales; weekly or biweekly outreach/monitoring contacts (telephone, telehealth, or in-person) totaling ≥20 minutes of clinical staff time per calendar month; review and documentation by the supervising physician or qualified health care professional; care plan development or revision; coordination of psychotherapy and pharmacotherapy appointments; and documentation of continuity of care and outreach attempts in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure |