Summary & Overview
HCPCS G4013: Mental/Behavioral and Psychiatry MIPS Specialty Set
HCPCS Level II code G4013 identifies the Mental/Behavioral and Psychiatry MIPS specialty set — a collection of quality and performance measures for clinicians in mental health, behavioral health, and psychiatry. Nationally, this code matters because it standardizes reporting for behavioral health outcomes and process measures, informing value-based payment adjustments and federal program compliance for participating providers.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will gain a concise view of the code’s role in quality reporting, the payer landscape that commonly recognizes this MIPS specialty set, and the clinical context in which the measures apply. The summary discusses the types of benchmarks typically associated with MIPS specialty sets, relevant policy updates affecting federal quality reporting, and operational implications for outpatient psychiatric and behavioral health practices.
This publication does not provide state-specific guidance. Data not available in the input is noted where relevant.
Billing Code Overview
HCPCS Level II code G4013 denotes the Mental/behavioral and psychiatry MIPS specialty set. This code represents a set of quality and performance measures tailored for clinicians practicing in mental health, behavioral health, and psychiatry who participate in the Merit-based Incentive Payment System (MIPS).
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Service type: Quality/performance measurement and reporting for mental/behavioral health and psychiatry clinicians
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Typical site of service: Outpatient behavioral health and psychiatric care settings, including office-based psychiatric practices and community mental health clinics
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 28-year-old adult referred to a psychiatry clinic for performance reporting under the Mental/Behavioral and Psychiatry MIPS specialty set (G4013). The patient presents with new-onset major depressive disorder and comorbid generalized anxiety disorder, requesting both medication management and psychotherapy. The clinical workflow begins with an intake visit where the psychiatrist or behavioral health clinician documents history, symptom scales (PHQ-9, GAD-7), current medications, and comorbidities. The clinician establishes a treatment plan, prescribes or adjusts psychotropic medication, and schedules follow-up visits. Relevant quality measures from the MIPS specialty set are captured during visits (for example, depression screening, follow-up after hospitalization for mental illness, suicide risk assessment). Data capture includes structured fields for diagnosis, interventions, medication reconciliation, and standardized outcome measures to satisfy reporting requirements to payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When additional documentation supports substantially greater work than typically required for the service (e.g., extended psychiatric evaluation due to complex comorbidity). |