The Centers for Medicare & Medicaid Services (CMS) has finalized several changes that significantly expand the scope of behavioral health services, incorporating new coverage for digital treatments and crisis intervention codes. These updates aim to enhance access to behavioral health care, especially in digital and remote settings, and address evolving patient needs.
Key Updates to Behavioral Health Services
Safety Planning Interventions (HCPCS Code G0560)
A major change is the finalization of HCPCS code G0560 for safety planning interventions in patients at risk of suicide or substance use crises. Previously a placeholder code, it is now a stand-alone code. The description has been expanded to include more detailed language on substance use crises, and it specifies that the intervention must be at least 20 minutes long. This new code ensures providers can be reimbursed for time spent creating personalized safety plans, which include identifying warning signs of crises and connecting patients to support systems.
Sonda Kunzi, president of Coding Advantage, views this as a significant win for behavioral health providers, particularly those who have previously lacked reimbursement for such interventions. However, Kunzi notes that non-psych providers, who may not typically engage in safety planning, may find it challenging to incorporate this practice into their routines.
Post-Discharge Telephonic Follow-Up (HCPCS Code G0544)
CMS also introduced HCPCS code G0544 for telephonic follow-ups with patients after they are discharged from emergency departments for behavioral health or crisis encounters. This code allows providers to conduct up to four phone calls per month to support ongoing care, with at least one real-time interaction required per month. The service can be provided by auxiliary personnel under the supervision of a billing provider, but verbal or written consent must be obtained from the patient.
Digital Mental Health Treatment (DMHT)
A significant advancement in behavioral health services is the introduction of Digital Mental Health Treatment (DMHT), which includes self-directed therapies such as digital cognitive behavioral therapy (CBT) through devices like smartphones. Beginning in 2025, Medicare will reimburse for DMHT services through HCPCS codes G0552, G0553, and G0554, which cover device supply, initial education, and treatment management.
For reimbursement, the DMHT service requires at least one interactive communication with the patient or caregiver each month. Providers will need to monitor the patient’s response to the therapy and adjust their behavioral health plans accordingly. While this opens new avenues for treatment, it is important to note that DMHT services differ from remote therapeutic monitoring devices like those used for therapy adherence (CPT code 98978).
Interprofessional Consultation and Referral Codes
CMS has also finalized several interprofessional consultation and referral codes for mental health diagnosis and treatment. These codes, ranging from G0546 to G0549, are time-based and designed to facilitate communication between healthcare providers regarding mental health treatment. Additionally, two more codes, G0550 and G0551, will be available for telephonic or electronic health record-based assessments and referrals.
These new codes will be reimbursed under Medicare’s 2025 Part B fee schedule, helping to support collaboration between specialists and primary care providers in managing mental health conditions.
Conclusion
These changes mark a significant step forward in making behavioral health services more accessible and comprehensive, especially through digital and remote care options. The new codes for safety planning interventions, post-discharge follow-up, and DMHT will provide providers with more opportunities for reimbursement, while interprofessional consultation codes will support better coordination of care.
Frequently Asked Questions (FAQs)
Q: What is HCPCS code G0560?
A: HCPCS code G0560 covers safety planning interventions for patients at risk of suicidal or substance use-related crises. It involves creating a personalized safety plan and must be at least 20 minutes long.
Q: What are the new codes for digital mental health treatment (DMHT)?
A: Beginning in 2025, Medicare will reimburse for DMHT services through HCPCS codes G0552, G0553, and G0554, which cover the supply of DMHT devices, treatment management, and ongoing patient support.
Q: Can non-psych providers use the new safety planning intervention code?
A: While non-psych providers can use the safety planning intervention code, it may not be typical for them to engage in such practices. Providers will need to assess whether they have the time and resources to incorporate safety planning into their encounters.
Q: What is the purpose of HCPCS code G0544?
A: HCPCS code G0544 is used for post-discharge telephonic follow-up contacts after a behavioral health or crisis encounter in the emergency department. It allows up to four calls per month to support patient recovery.
Q: How do interprofessional consultation codes work?
A: CMS has finalized several interprofessional consultation and referral codes (G0546 to G0549) for mental health diagnosis and treatment. These codes enable communication between healthcare providers and will be reimbursed under the 2025 Part B fee schedule.
Q: When will DMHT services become payable by Medicare?
A: Medicare will begin reimbursing for DMHT services in 2025. Providers will be able to bill for services related to digital cognitive behavioral therapy, including device supply and treatment management.