Summary & Overview

HCPCS G0551: Interprofessional Mental Health E-Consult, 30 Minutes

HCPCS Level II code G0551 covers a 30-minute interprofessional referral or consultation conducted by a treating or requesting practitioner in a specialty statutorily limited to the diagnosis and treatment of mental illness, using telephone, internet, or electronic health record communication. The code codifies clinician-to-clinician remote collaboration for complex behavioral health cases where specialty input is required without a direct patient encounter. Nationally, this code matters as telehealth and virtual care models expand behavioral health access and as payers formalize payment for asynchronous and synchronous interprofessional communications.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage context and typical use cases for G0551, how the service is defined, common clinical settings where it applies, and practical considerations for billing and documentation. The publication also summarizes available benchmarks and recent policy updates affecting interprofessional electronic consultation services, and situates G0551 within broader clinical workflows for mental health specialty referrals.

Data not available in the input for specific associated taxonomies, ICD-10 diagnosis lists, related codes, or payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0551HCPCS Level IIbehavioral healthtelehealthinterprofessional consulte-consultelectronic referralremote carebilling

Billing Code Overview

HCPCS Level II code G0551 describes an interprofessional telephone/internet/electronic health record referral service provided by a treating or requesting practitioner in a specialty whose covered services are limited by statute to the diagnosis and treatment of mental illness. The code represents a 30-minute consultation interaction conducted via telephone, internet, or through electronic health record communication between clinicians.

Service type: Interprofessional consultation/referral service for mental health specialties conducted remotely via telephone, internet, or electronic health record
Typical site of service: Remote/virtual or clinician-to-clinician communication; originating clinician's practice location or any setting where the treating/requesting practitioner is located

Clinical & Coding Specifications

Clinical Context

A community psychiatrist receives an EHR-based consultation request from a primary care physician regarding a 34-year-old patient with worsening major depressive disorder with suicidal ideation and complex medication history. The treating/requesting practitioner is a psychiatrist (a specialty limited by statute to mental illness services) who submits an interprofessional electronic referral via secure messaging summarizing the patient’s current symptoms, medication trials, safety concerns, and recent PHQ-9 score. The consulting mental health specialist reviews the primary record, communicates with the treating/requesting practitioner by secure portal message and telephone, and documents a 30-minute interprofessional management and care coordination session in the EHR recommending adjustments to psychotropic medications, safety planning, and suggestions for psychotherapy resources. The workflow includes: initial referral from the treating/requesting practitioner, retrieval and review of relevant records by the consulting specialist, asynchronous electronic communication and/or telephone discussion totaling 30 minutes, documentation of recommendations in the EHR, and follow-up communication to confirm implementation. Typical site of service is outpatient behavioral health or physician office with electronic health record and telecommunication capabilities.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When the interprofessional consult required substantially greater work or complexity than typical 30-minute referral (use only with payer acceptance).
`23`	Unusual anesthesia	Not typically used for this service; not applicable unless unusual anesthesia is involved (rare for this code).
`52`	Reduced services	When the interprofessional activity was partially reduced or abbreviated relative to full service.
`53`	Discontinued procedure	If the referral service was started but discontinued due to patient or practitioner decision before substantive work.
`55`	Split/shared services	When multiple clinicians share professional components, if payer policy allows applying to interprofessional services.
`62`	Two surgeons	Generally not applicable to psychiatry; included when two clinicians of equal specialty jointly provide service and payer recognizes modifier.
`78`	Return to OR following initial procedure	Not applicable to this code; included rarely when service relates to post-procedural consults.
`80`	Assistant at surgery	Not applicable to this psychiatry service but listed among common modifiers.
`82`	Assistant not available (when surgeon assistant would typically be required)	Uncommon for this code; rarely used.
`AF`	HCPCS modifiers for workers' compensation or specified payer programs	Use when required by specific payer programs to indicate claim type.
`QX`	Qualified nonphysician practitioner (modifier)	When a qualified nonphysician practitioner furnished the interprofessional consult under applicable supervision rules.
`QY`	Telementoring or other defined service modifier	When payer requires designation of a specific non-standard service type (use per payer policy).
`SH`	Modifier for speech-language services	Not typically used for this psychiatric interprofessional service; included only if behavioral health service incorporates speech-language specific components as allowed.
`QK`	Anesthesia modifier for medically directed services	Not applicable to this code but occasionally used in claims bundles for complex care coordination.

Taxonomy Code	Specialty	Notes
`101Y00000X`	Psychiatry & Neurology	Psychiatrists who review consult requests and provide interprofessional recommendations.
`2084P0800X`	Child and Adolescent Psychiatry	Specialists who provide interprofessional advice for pediatric/adolescent mental health referrals.
`1223U0005X`	Behavioral Health & Social Service Providers	Licensed clinical social workers or behavioral health coordinators participating in care coordination and consult facilitation.
`103T00000X`	Psychology	Psychologists who may provide interprofessional recommendations within scope and payer rules.
`364S00000X`	Addiction Medicine	Addiction psychiatrists consulted for substance-related comorbidities during interprofessional referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.1`	Major depressive disorder, single episode, moderate	Common diagnosis prompting interprofessional psychiatric consultation for medication management and safety planning.
`F33.1`	Major depressive disorder, recurrent, moderate	Frequently associated with referrals for specialist input on treatment-resistant features or medication changes.
`F41.1`	Generalized anxiety disorder	Often comorbid with depressive disorders and may require psychiatrist input for complex pharmacotherapy.
`F32.9`	Major depressive disorder, single episode, unspecified	Used when depressive symptoms prompt interprofessional review and more specific coding is deferred.
`F43.21`	Adjustment disorder with depressed mood	May trigger specialist recommendations for psychotherapy resources and brief medication adjustments.
`F20.9`	Schizophrenia, unspecified	Serious mental illness occasionally prompts interprofessional management for antipsychotic selection and monitoring.
`F11.20`	Opioid dependence, uncomplicated	Substance use comorbidity that often requires psychiatric/addiction specialist consultation within interprofessional workflows.
`F32.3`	Major depressive disorder with psychotic features	High-acuity diagnosis that commonly necessitates specialist input via interprofessional referral.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99446`	Interprofessional telephone/Internet/electronic health record assessment and management service, 5–10 minutes of medical consultative discussion and review	Shorter interprofessional consult codes performed when the consult is brief; may be billed for shorter-duration interactions compared with `G0551` (30 minutes specialty-limited service).
`99447`	Interprofessional telephone/Internet/electronic health record assessment and management service, 11–20 minutes of medical consultative discussion and review	Used when interprofessional consultation time falls in the 11–20 minute range; complements `G0551` when payers accept CPT for mental health specialty consults.
`99448`	Interprofessional telephone/Internet/electronic health record assessment and management service, 21–30 minutes of medical consultative discussion and review	Time-equivalent CPT code for a 21–30 minute interprofessional consult; clinically similar to `G0551` but `G0551` is specific to psychiatrists/mental health statutory limitations.
`99451`	Interprofessional telephone/Internet/electronic health record referral service, 5 minutes or more of medical consultative time, typically performed by a consultative physician	General interprofessional consult code used when consultative physician documents review and recommendations; may be used in workflows where payer policies permit instead of `G0551`.
`90833`	Psychotherapy with evaluation and management (E/M) services, 30 minutes	Face-to-face psychotherapy paired with E/M; may occur before or after an interprofessional consult when direct patient psychotherapy is indicated.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity, typically 25 minutes	Treating/requesting practitioner E/M visit that may generate the interprofessional referral; documents initial assessment prompting consult.