G8960 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G8960: Clinician Non-Communication in Major Depressive Disorder

HCPCS Level II code G8960 documents an instance in which a clinician treating major depressive disorder did not communicate with the clinician managing a comorbid condition, with no reason specified. The code is used to capture gaps in inter-clinician communication that may affect patient safety and care coordination across behavioral health and medical services. Nationally, capturing these events is important for quality monitoring and administrative records related to care transitions and interdisciplinary management.

Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise explanation of the code's clinical meaning, typical service setting, and how it fits into documentation and billing workflows. The publication also outlines common modifiers associated with related HCPCS reporting, notes where input data were unavailable, and points to areas where policy and payer guidance can influence use of the code. The content provides operational clarity for billing teams, compliance staff, and clinical leaders seeking to interpret G8960 in the context of national billing practices and quality reporting.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8960HCPCS Level IImajor depressive disordercare coordinationcommunicationbehavioral healthoutpatientquality documentation

Billing Code Overview

HCPCS Level II code G8960 denotes that a clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given. This code documents a lapse in communication between the clinician responsible for managing major depressive disorder and the clinician treating a comorbid medical condition.

Service type: Care coordination / communication documentation
Typical site of service: Outpatient behavioral health or medical clinic where treatment for major depressive disorder is provided

Clinical & Coding Specifications

Clinical Context

A patient with major depressive disorder (MDD) is receiving psychiatric care from a behavioral health clinician (psychiatrist, psychiatric nurse practitioner, or psychologist). The patient is concurrently being treated by a separate clinician for a comorbid medical condition (for example, diabetes mellitus, chronic pain, or a cardiovascular condition). During a scheduled psychiatric follow-up visit, the treating mental health clinician documents that they did not communicate relevant information (medication changes, suicidal ideation, functional decline, or psychotherapy plan) to the clinician managing the comorbid condition and no reason for the lack of communication was recorded. The usual clinical workflow would include review of the patient’s current medical record, medication reconciliation, assessment of whether comorbid medical clinicians need notification, and initiation of documented communication (secure message, telephone call, or consult note) when indicated. In this scenario, the behavioral health clinician documents assessment and treatment for MDD but records that communication to the comorbid-condition clinician did not occur and no rationale is provided, triggering use of billing code G8960 to indicate lack of clinician-to-clinician communication for quality reporting or administrative tracking. Typical site of service is an outpatient behavioral health clinic or psychiatric office; care coordination normally occurs by phone, secure electronic message, or routed clinical summary to the primary care or specialty clinician.

Coding Specifications

Below are the most clinically relevant modifiers for use in encounters involving clinician communication or coordination issues; selection depends on payer rules and encounter specifics.

Modifier	Description

HCPCS G2012: Brief Virtual Check-In for Established Patients

HCPCS-G9485-REMOTE-IN-HOME-NEW-PATIENT-EVALUATION-MANAGEMENT-TELEHEALTH

HCPCS G9485: Remote In-Home New Patient Evaluation and Management

HCPCS-G9828-HER2-TARGETED-THERAPY-INITIAL-TREATMENT

HCPCS G9828: Her2-Targeted Therapy, Initial Course of Treatment

HCPCS-G0202-SCREENING-MAMMOGRAPHY-BILATERAL-2-VIEW-CAD

HCPCS G0202: Screening Mammography, Bilateral (2-View), with CAD

HCPCS-G8990-THERAPY-PRIMARY-FUNCTIONAL-LIMITATION-STATUS

HCPCS G8990: Other Therapy Primary Functional Limitation, Current Status

HCPCS-G0558-ADVANCED-PRIMARY-CARE-MANAGEMENT

HCPCS G0558: Advanced Primary Care Management for Complex Chronic Patients

HCPCS-G8924-SPIROMETRY-FEV1-FVC-UNDER-70

HCPCS G8924: Spirometry Results Documented (FEV1/FVC < 70%)

HCPCS-G0104-FLEXIBLE-SIGMOIDOSCOPY-COLORECTAL-SCREENING

HCPCS G0104: Colorectal Cancer Screening, Flexible Sigmoidoscopy

HCPCS-G9904-MEDICAL-REASON-NO-TOBACCO-SCREENING

HCPCS G9904: Documentation of Medical Reason for Not Screening for Tobacco Use

HCPCS-G9749-PALLIATIVE-DIALYSIS-WITH-CATHETER

HCPCS G9749: Palliative Dialysis with Catheter

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry & Neurology - Psychiatry	Typical clinicians diagnosing and managing major depressive disorder.
`363L00000X`	Behavioral Health & Social Service Providers - Psychiatric Nurse Practitioner	Common providers delivering outpatient psychiatric medication management.
`103T00000X`	Psychological & Neuropsychological Testing - Psychologist	Provides psychotherapy and psychological assessment; documents care coordination needs.
`207Q00000X`	Family Medicine	Primary care clinicians often manage comorbid medical conditions and receive communications.
`207R00000X`	Internal Medicine	Specialists managing chronic medical comorbidities who may need psychiatric input.

Related Diagnoses

Common diagnoses associated with encounters where clinician-to-clinician communication about major depressive disorder is expected are listed below.

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	Frequently used for initial or single-episode depressive presentations requiring coordination with medical clinicians.
`F33.1`	Major depressive disorder, recurrent, moderate	Common diagnosis for ongoing psychiatric treatment where medication changes or risk concerns warrant communication.
`F33.2`	Major depressive disorder, recurrent severe without psychotic features	Severe cases often require closer coordination with medical teams managing comorbidities.
`Z63.0`	Problems in relationship with spouse or partner	Psychosocial stressors often documented and may affect medical comorbidities, prompting inter-clinician communication.
`R45.851`	Suicidal ideation	Critical clinical finding that typically triggers immediate communication to other treating clinicians; absence of documented communication is notable.
`E11.9`	Type 2 diabetes mellitus without complications	Example common comorbid medical condition where psychiatric medication changes can affect glycemic control and require coordination.
`I10`	Essential (primary) hypertension	Common comorbidity where certain antidepressants or psychotropic agents may interact with antihypertensives, necessitating clinician-to-clinician communication.

Related CPT Codes

Common CPT codes performed alongside psychiatric care and care coordination are listed below.

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (no medical services)	Often used for initial psychiatric diagnostic assessment for MDD before ongoing care coordination.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Typical follow-up outpatient E/M visit where documentation may note lack of communication to comorbid-condition clinician.
`99492`	Initial psychiatric collaborative care management, first month	Used when collaborative care model is in place; highlights expected communication pathways that were not completed.
`99493`	Subsequent psychiatric collaborative care management, monthly	Monthly follow-up in collaborative care models where coordination with medical clinicians is standard.
`99354`	Prolonged service in the office or outpatient onsite, first hour (face-to-face)	Used when extended time is spent on complex coordination or counseling; may accompany documentation explaining communication status.

`22`	Increased procedural services	When substantially greater work is performed than typical for the service, e.g., extended coordination tasks documented in addition to the visit.
`23`	Unusual anesthesia	Not typically used for this code; included for completeness if anesthesia is unusually required for a related procedure.
`52`	Reduced services	When the service is partially reduced or not completed as planned (e.g., shortened encounter).
`53`	Discontinued procedure	If a planned procedure or coordination activity was started but terminated.
`54`	Surgical care only	Not commonly applicable; reserved for surgical scenarios when only surgical portion is billed.
`55`	Postoperative management only	Not commonly applicable to this code; applies if only postoperative care is provided by another clinician.
`56`	Preoperative management only	Rarely applicable; for preoperative management by another clinician.
`62`	Two surgeons	Not applicable in typical behavioral health encounters; used when two surgeons share operation.
`AS`	Accredited surgical assistant	Not applicable to behavioral health; included for multispecialty claim contexts.
`CO`	Services related to a clinical trial (when used by some payers)	Used when the encounter relates to clinical trial coordination and reporting; check payer policy.
`CQ`	Service furnished by a resident without an attending physician present	Use when a resident provided the service without direct attending oversight and documentation supports it.
`FX`	Indicates a single claim line may be nonreimbursable (payer-specific)	Applied when a payer requires specific flagging of a problematic claim line.
`FY`	Indicates services provided under an alternate payment mechanism	Use when services are billed under an alternative reimbursement arrangement per payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable to behavioral health; included for completeness if anesthesia services appear on the claim.

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