How to Secure Provider Reimbursement for G0017 and G0018 Codes
In the healthcare billing landscape, accuracy and precise documentation are the main challenges that everyone faces. And this even more complicated with some specialized services like psychiatric care. In this post, we’ll see what providers need to know about G0017 and G0018, including billing scenarios, required documentation, applicable modifiers, recent CMS updates, and how Shoreline Medical Billing Company can support seamless reimbursement. This post aims to enhance the understanding of these codes and improve the revenue cycle management.
Understanding the codes G0017 and G0018
The Healthcare Common Procedure Coding System (HCPCS) Level II codes G0017 and G0018 were introduced by the Centers for Medicare & Medicaid Services (CMS) on Jan 1,2024 to address specific psychotherapy services provided in certain settings, particularly for Medicare beneficiaries. They are meant to provide correct compensation for the management of mental health issues in a non-facility setting during a crisis scenario.
Official Code Descriptor:
G0017: Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes.
G0018: Crisis Psychotherapy for each additional 30 minutes (listed separately in addition to code for primary service).
When and where it used?
These codes are used by licensed clinical psychologists or social workers for handling critical psychotherapy sessions provided in a non-facility setting outside the hospital, such as patient’s home, community center, school etc, where the provider tries to manage the urgent mental health needs of the patients, such as acute anxiety, thoughts of suicide, or episode of severe depressions. They can also be applied for telehealth services provided. By using these codes, psychiatrists get the fair compensation for their expertise and time sensitive care they render.
Documentation standards for G0017 and G0018
We should always make sure that documents submitted to support these codes must be accurate and clear for getting the maximum reimbursement. CMS always looks for detailed records to justify the medical necessity of crisis psychotherapy which follows Medicare regulations. The following elements should be included in the medical record:
- Patient Identification: Mention the Full patient details, including name, date of birth, and Medicare beneficiary identifier.
- Date and Time of Service: Note down the exact date and duration of the psychotherapy session, note whether it lasted 60 minutes or more.
- Description of the Crisis condition: A detailed narrative of the patient’s mental health condition, including symptoms like suicidal ideation, severe agitation and the immediate risk to the patient or others should be mentioned.
- Document the Medical Necessity: Give a clear explanation of why the crisis intervention was necessary, including the patient’s diagnosis of previous disorders (e.g., major depressive disorder, bipolar disorder) and also about the urgency of the situation.
- Intervention Details: Give the description of the what all psychotherapy techniques used, such as cognitive-behavioral therapy, safety planning, or de-escalation strategies.
- Setting of Service: We should always mention the POS (Place of Service) codes while using G0017 or G0018. However, we cannot use the POS-11(Office) codes.
- Check for the Provider Eligibility Only a qualified healthcare professional, such as a psychiatrist or licensed clinical social worker can submit these codes for reimbursement.
- Outcome of Intervention: Give a summary of the patient’s response to the intervention, including stabilization measures and any follow-up care needed must be mentioned.
Some common lists of modifiers that can be used along with G0017 and G0018
Modifiers provide additional information about the service without altering the code’s definition. The following are some common modifiers that may be appended when appropriate:
| Modifier 95 | Service was provided via telehealth. |
| Modifier 59 | Indicates a distinct or independent service from other services performed on the same day. |
| Modifier 25 | For a separate identifiable E/M service |
| Modifier KX | Indicates that the service meets specific coverage criteria, often used to confirm medical necessity for Medicare claims. |
We at Shoreline Medical Billing Company assists healthcare professionals in creating comprehensive documentation that meets CMS standards, reducing the risk of audits and ensuring timely reimbursement.
The introduction of G0017 and G0018 by CMS marks a positive shift in recognizing the essential work done by mental health providers under the collaborative care model. While the billing rules are clear, successful reimbursement depends on accurate documentation, correct modifier usage, and awareness of updates.
We at Shoreline Medical Billing Company specializes in guiding healthcare professionals through the entire process of Medicare billing, ensuring accurate coding and maximized reimbursements for services like those represented by G0017 and G0018.
FAQs about the codes G0017 & G0018.
Q1. What qualifies as a “crisis” for using G0017 and G0018?
+A crisis is an urgent situation requiring immediate intervention to prevent harm to the patient or others, such as suicidal ideation, severe agitation, or acute psychotic episodes.
Q2. Can all physicians bill for G0017 or G0018?
+No. Only Licensed clinical psychologists and social workers are authorized to bill using these codes.
Q3. Is face-to-face contact required for billing G0017?
+No. These are non-face-to-face care management services. Phone calls, chart reviews, care planning, and interprofessional consultations are all billable under these codes.
Q4. Can G0018 be billed multiple times?
+Yes. It can be billed for every additional 20-minutes of care provided beyond the first 20 minutes within the same calendar month.
Q5. Can G0017 and G0018 be billed for telehealth services?
+Yes, we can also use these codes for telehealth services by appending the Modifier 95 to claim.
Q6. Is ShorelineMB the same as Shoreline Healthcare Technologies?
+Yes, ShorelineMB.com is the official website of Shoreline Healthcare Technologies, a leading provider of medical billing and RCM services.
Sharanya Rajmohan
Content Writer
Sharanya brings clarity to the complexities of medical billing and healthcare regulations. With a knack for turning industry shifts into straightforward, actionable insights, her blogs help readers stay informed without the jargon.
Contact Shoreline Medical Company today for more information.