CurrentAnthemPolicy N/A

HCPC Codes Allow for Payment for Coordinating Behavioral Health Services

Defines Anthem's stance that specific HCPC codes (collaborative care, case management, cognitive assessment) effective Jan 1, 2017 allow payment to Medicare Advantage primary care providers for coordinating and integrating behavioral health services.

Policy Summary

PayerAnthem

PolicyHCPC Codes Allow for Payment for Coordinating Behavioral Health Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2017

Next Review DateN/A

Key ActionProviders may bill the listed HCPC codes for collaborative care and care management activities including outreach, assessment with validated scales, registry tracking, weekly psychiatric consultation, brief evidence-based interventions, care planning, coordination, and relapse prevention.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

G0502–G0507HCPC codes referenced for payment

Jan 1, 2017Effective date

20–70+ minTime ranges

Medicare AdvantageIntended audience

Coverage Criteria

Code-specific coverage criteria

Coverage applies when services meet the code-specific required elements and time thresholds.

ALL of the following

Time threshold: first 70 minutes in the first calendar month of behavioral health care manager activities.
Care delivered in consultation with a psychiatric consultant and directed by the treating physician or other qualified health care professional.
Outreach to and engagement in treatment directed by the treating physician or other qualified health care professional.
Initial assessment including administration of validated rating scales and development of an individualized treatment plan.

Policy Summary

PayerAnthem

PolicyHCPC Codes Allow for Payment for Coordinating Behavioral Health Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2017

Next Review DateN/A

SourceLink

On This Page

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ALL of the following

Time threshold: first 60 minutes in a subsequent calendar month of behavioral health care manager activities.
Care delivered in consultation with a psychiatric consultant and directed by the treating physician or other qualified health care professional.
Tracking patient follow-up and progress using the registry with appropriate documentation.
Participation in weekly caseload consultation with the psychiatric consultant.
Ongoing collaboration and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers.
Additional review of progress and recommendations for changes in treatment as indicated, including medications based on psychiatric consultant recommendations.
Provision of brief interventions using evidence-based techniques (e.g., behavioral activation, motivational interviewing, other focused treatment strategies).
Monitoring of patient outcomes using validated rating scales and relapse prevention planning as patients achieve remission or other treatment goals and prepare for discharge from active treatment.

HCPCS Codes and Time Thresholds

Behavioral health collaborative care and care management HCPC codesHCPCSCovered

G0502	Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities
G0503	Subsequent psychiatric collaborative care management; first 60 minutes in a subsequent month of behavioral health care manager activities
G0504	Each additional 30 minutes in a calendar month of behavioral health care manager activities (list separately in addition to primary procedure; use in conjunction with G0502/G0503)
G0507	Care management services for behavioral health conditions; at least 20 minutes of clinical staff time per calendar month

Time thresholds

G0502Initial psychiatric collaborative care management — first 70 minutes in the first calendar month of behavioral health care manager activities

G0503Subsequent psychiatric collaborative care management — first 60 minutes in a subsequent calendar month

G0504Each additional 30 minutes in a calendar month (billed in addition to G0502/G0503)

G0507Care management services for behavioral health conditions — at least 20 minutes of clinical staff time per calendar month

Billing and Documentation Actions

Billing Rule

Bill only when HCPC code time and required elements are met (G0502, G0503, G0504, G0507)

Providers may bill the listed HCPC codes for collaborative care and care management activities when the service meets the code-specific required elements and time thresholds. Billing is appropriate for outreach and engagement directed by the treating physician or qualified health care professional; initial assessment including administration of validated rating scales and development of an individualized treatment plan; registry entry and tracking of follow-up and progress with appropriate documentation; participation in weekly caseload consultation with a psychiatric consultant; provision of brief evidence-based interventions (e.g., behavioral activation, motivational interviewing); ongoing collaboration, coordination, and review with the treating physician and other mental health providers; monitoring of outcomes and relapse prevention planning; and additional time-based increments as specified by the codes.

Use G0502 for initial psychiatric collaborative care management (first 70 minutes in the first calendar month) when all required elements are met, including outreach/engagement, initial assessment with validated scales, individualized treatment plan, psychiatric consultant review, registry entry/tracking, weekly caseload consultation, and brief evidence-based interventions.
Use G0503 for subsequent psychiatric collaborative care management (first 60 minutes in a subsequent month) when required elements are met, including registry tracking with documentation, weekly caseload consultation, ongoing collaboration/coordination with treating providers, review and recommendations for treatment changes, brief interventions, outcome monitoring with validated scales, and relapse prevention planning.
Use G0504 to report each additional 30 minutes in a calendar month as an add-on to G0502 or G0503.
Use G0507 for care management services for behavioral health conditions when at least 20 minutes of clinical staff time per calendar month is provided (assessment or follow-up monitoring using validated scales; care planning; facilitating/ coordinating psychotherapy, pharmacotherapy, counseling, psychiatric consultation, and continuity of care).

Definitions

Definitions — G0502 / G0503 / G0504 (Psychiatric Collaborative Care Management)

ScopePsychiatric collaborative care management delivered by a behavioral health care manager in consultation with a psychiatric consultant and directed by the treating physician or other qualified health care professional

Core activitiesOutreach/engagement; initial assessment with validated rating scales; development of an individualized treatment plan; entering patient in a registry and tracking follow-up and progress

Care team consultationParticipation in weekly caseload consultation with the psychiatric consultant and review of the treatment plan with modifications as recommended

InterventionsProvision of brief, evidence‑based interventions such as behavioral activation and motivational interviewing

Definition — G0507 (Care Management Services for Behavioral Health Conditions)

ScopeCare management services for behavioral health conditions provided by clinical staff and directed by a physician or other qualified health care professional

Time requirementAt least 20 minutes of clinical staff time per calendar month

Core activitiesInitial assessment or follow‑up monitoring using validated rating scales; behavioral health care planning; revision of plans for patients not progressing

Care coordinationFacilitating and coordinating treatment (psychotherapy, pharmacotherapy, counseling, psychiatric consultation) and ensuring continuity of care with a designated team member