G0549 Interprofessional Mental Health Consult Reimbursement | OpenPayer

Summary & Overview

HCPCS G0549: Interprofessional Mental Health Consult, 31+ Minutes

HCPCS Level II code G0549 represents an interprofessional consultative assessment and management service provided by a practitioner in a specialty limited by statute to the diagnosis and treatment of mental illness. The code captures remote or telephonic interprofessional work — including review, discussion and a verbal and written report to the treating practitioner — when the consultative activity totals 31 or more minutes. Nationally, this code matters as payers expand recognition of interprofessional and telehealth-based collaboration in mental health care and as programs seek clearer billing pathways for specialty-to-specialty and specialty-to-primary care consults.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what the code represents, common modifiers and billing context, and guidance on where to find payer-specific coverage rules. The publication covers benchmark themes and policy developments relevant to interprofessional telehealth consults in mental health, practical considerations for billing and documentation, and comparisons of payer approaches where available. Data not available in the input will be identified as such in the relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0549HCPCS Level IIinterprofessional consulttelehealthmental healthcare coordinationEHR consultationbilling and coding

Billing Code Overview

HCPCS Level II code G0549 describes an interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to the diagnosis and treatment of mental illness. The service requires 31 or more minutes of medical consultative discussion and review and includes a verbal and written report to the patient's treating or requesting practitioner.

Service type: Interprofessional consultative assessment and management (telephone/internet/EHR)

Typical site of service: Specialty clinician office or remote/telehealth setting supporting interprofessional electronic or telephonic consultation

Clinical & Coding Specifications

Clinical Context

A 42-year-old psychiatrist who provides consultative services to primary care and emergency department clinicians receives a request for an opinion regarding a complex patient with worsening major depressive disorder and suicidality risk. The requesting practitioner sends the medical record and specific questions via the electronic health record messaging system. The consulting psychiatrist performs an interprofessional review of the chart, conducts a 40-minute consultative discussion with the treating clinician over the telephone and documents a verbal and written report back to the treating/requesting practitioner. The workflow includes: the requesting clinician detailing the clinical question and transferring records; the consultant reviewing prior notes, medication lists, and risk assessments in the EHR; a synchronous or asynchronous telephone discussion lasting 31 or more minutes; formulation of recommendations for medication changes and safety planning; and delivery of a written consult note or secure EHR message to the requesting practitioner. Typical sites of service include outpatient behavioral health clinics, inpatient psychiatric consultation services supporting emergency departments or medical floors, and telehealth/telemedicine settings where the consultant’s statutory scope is limited to mental illness diagnosis and treatment. The service is non-face-to-face between the consultant and the patient and is billed by the consulting mental health specialist to report interprofessional telephone/internet/EHR assessment and management for 31 or more minutes using G0549.

Coding Specifications

Modifiers selected reflect common billing scenarios for interprofessional consults by psychiatrists and other mental health specialists.

Modifier	Description

HCPCS G9614: Photodocumentation of Incomplete Cecal Landmarks

HCPCS-G2131-PATIENTS-81-YEARS-AND-OLDER-FRAILTY

HCPCS G2131: Patients 81 Years and Older with Frailty

HCPCS-G2004-POST-DISCHARGE-HOME-VISIT-NEW-PATIENT-60MIN

HCPCS G2004: Comprehensive 60-Minute Post-Discharge In-Home Visit

HCPCS-G9965-MISSED-WELL-CHILD-VISIT-PRIMARY-CARE

HCPCS G9965: Missed Well-Child Visit with Primary Care Provider

HCPCS-G2149-DOCUMENTATION-NO-MULTIMODAL-PAIN-MANAGEMENT

HCPCS G2149: Documentation of Reason for Not Using Multimodal Pain Management

HCPCS-G8578-POSTOPERATIVE-CARDIAC-COMPLICATION-MANAGEMENT-NO-RE-EXPLORATION

HCPCS G8578: Postoperative Cardiac Complication Management, No Re-exploration Required

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G9967-CHILDREN-NOT-SCREENED-DEVELOPMENTAL-RISK

HCPCS G9967: Children Not Screened for Developmental/Behavioral Risk

HCPCS-G0304-PRE-OPERATIVE-PULMONARY-PREP-LVRS

HCPCS G0304: Pre-operative Pulmonary Preparation for LVRS, 1–9 Days

HCPCS-G0434-DRUG-SCREEN-NON-CHROMATOGRAPHIC-MULTICLASS

HCPCS G0434: Non-Chromatographic Multiclass Drug Screen

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry & Neurology — Psychiatry	Primary specialty performing `G0549` interprofessional consults.
`2084N0400X`	Psychiatry & Neurology — Child & Adolescent Psychiatry	For consults involving pediatric/adolescent mental health cases.
`101YP2500X`	Physician Assistant	PAs in behavioral health who may coordinate or assist with consults under supervision where allowed.
`363L00000X`	Clinical Social Worker	Licensed clinical social workers who may document and facilitate interprofessional communications in behavioral health teams.
`207Q00000X`	Nurse Practitioner	Psychiatric-mental health nurse practitioners providing consultative reviews and recommendations.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.1`	Major depressive disorder, single episode, moderate	Common reason for psychiatric interprofessional consultation about medication management and safety planning.
`F33.2`	Major depressive disorder, recurrent severe without psychotic features	Frequent indication when a treating clinician requests specialist input for complex recurrent depression.
`F41.1`	Generalized anxiety disorder	Often co-occurs with depressive disorders prompting consultative recommendations on pharmacotherapy adjustments.
`F32.3`	Major depressive disorder, single episode, with psychotic symptoms	Higher complexity cases requiring specialist consultation for antipsychotic and safety considerations.
`R45.851`	Suicidal ideation	Urgent reason for interprofessional consults focused on risk assessment and disposition recommendations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (no medical services)	Often performed by the consultant when an in-person or telehealth diagnostic assessment follows the interprofessional recommendation.
`90833`	Psychotherapy with evaluation and management, 30 minutes (add-on)	May be billed by the treating practitioner for a follow-up psychotherapy session after consultant input; not billed concurrently by the consultant.
`90847`	Family psychotherapy (conjoint psychotherapy) (50 minutes)	May be performed by the treating clinician as part of implementing the consultant’s recommendations in outpatient care.
`99446`	Interprofessional telephone/Internet/EHR consultation by a physician 5-10 minutes of medical consultative discussion and review	Lower-time interprofessional consultation codes (`99446`-`99449`) are related E/M options for shorter consultative durations compared with `G0549`.
`99451`	Interprofessional telephone/Internet/EHR assessment and management service by a consultative physician, 5 or more minutes (no face-to-face patient contact)	Related interprofessional consult CPT code used when the consultant is a physician and the payer accepts CPT instead of HCPCS for such services.

`00`	No modifier — standard service indicator	Use when no specific modifier applies; standard submission for the consultant’s service.
`22`	Increased procedural services	Use when the consultation required substantially greater work or complexity than typical for `G0549`.
`23`	Unusual anesthesia — Not applicable clinically but CMS-standard	Rarely applicable; do not use for this non-procedural consult unless payer-specific rules require.
`29`	Professional component	Use when splitting professional and technical components among practitioners; uncommon for `G0549`.
`52`	Reduced services	Use if the consult was started but substantially reduced in time or scope and full `G0549` requirements not met.
`54`	Surgical care only	Not typically used — reserved for surgical providers who bill only surgical global period.
`55`	Postoperative management only	Not typically used for consultative interprofessional services.
`62`	Two surgeons	Use only when two surgeons share responsibility — generally not applicable for psychiatric `G0549`.
`78`	Unplanned return to the operating room	Not applicable to interprofessional psychiatric consults.
`80`	Assistant surgeon	Not applicable for this service.
`82`	Assistant surgeon (when a qualified resident is not available)	Not applicable.
`AF`	Ambulance response and transport	Use only if combined billing with emergency medical transport services per payer rules.
`CQ`	Service furnished under a contractual arrangement	Use when the consultant provides services under contract to another entity (for example, a hospitalist group requesting psychiatric consults).
`QX`	Ordering/Referring Provider Commercial Payor Not the Same as Rendering Provider	Use when billing systems require distinguishing ordering vs rendering providers in commercial payor submissions.

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