Summary & Overview
HCPCS G9742: Psychiatric Symptoms Assessed
HCPCS Level II code G9742 denotes an assessment of psychiatric symptoms and is used to document clinical evaluation of mood, anxiety, psychotic, or behavioral disturbances in ambulatory and outpatient behavioral health settings. This code matters nationally as payers and health systems increasingly track behavioral health assessments for care coordination, quality measurement, and population mental health management. Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and the clinical context for use. The publication summarizes payer coverage patterns and benchmarks where available, outlines relevant policy and billing considerations impacting reimbursement and documentation, and situates the code within common clinical workflows for integrated behavioral health and specialty psychiatry. The content is intended to help revenue cycle, compliance, and clinical leaders understand the role of G9742 in documenting psychiatric symptom assessments and to provide a reference for aligning clinical documentation with billing practices. Data not available in the input.
Billing Code Overview
HCPCS Level II code G9742 represents an assessment of psychiatric symptoms. The code denotes a clinical service focused on evaluating the presence, severity, and clinical features of psychiatric symptoms, including mood, anxiety, psychotic, or behavioral disturbances.
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Service type: Psychiatric symptom assessment
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Typical site of service: Outpatient behavioral health settings, psychiatric clinics, primary care offices with behavioral health integration, community mental health centers, or similar ambulatory care environments
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult or adolescent presenting to an outpatient behavioral health clinic, primary care office, or emergency department with new or worsening psychiatric symptoms such as depression, anxiety, suicidal ideation, psychosis, agitation, or significant mood instability. The clinician — often a psychiatrist, psychiatric nurse practitioner, psychologist, or primary care physician with behavioral health training — performs a focused psychiatric symptom assessment to determine symptom severity, risk (including safety and suicide risk), need for urgent intervention, and disposition.
The clinical workflow commonly includes triage by nursing staff, a focused history of present illness and mental status examination, screening for suicidal or homicidal ideation, assessment of substance use and medication adherence, review of psychosocial stressors, and documentation of findings. The assessment guides decisions about medication changes, initiation of psychotherapy referrals, safety planning, crisis services, need for higher level of care (inpatient psychiatric admission), or discharge with outpatient follow-up. Documentation typically records time spent, symptoms assessed, risk level, and recommended plan of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day | Use when a distinct E/M visit is provided in addition to the psychiatric symptom assessment |