G0017, Psychotherapy for crisis furnished in an applicable site of service (any place
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
4.70
Facility
$172.01
Non-Facility
$218.44
Documentation Required
- Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
- When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
- When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
- Billing and coding are dependent on the coverage indications, limitations, and medical necessity described in the associated LCD L34616; follow LCD L34616 requirements when filing claims.
Key Coverage Criteria
- Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
- CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
- HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
- A psychiatric diagnostic evaluation (CPT 90791) or with medical services (CPT 90792) may be performed once at the onset of an illness or suspected illness.
- A psychiatric diagnostic evaluation (90791/90792) may be repeated for the same patient after an extended break (~6 months) in treatment, upon admission to inpatient psychiatric status, for a significant change in mental status, in a patient with established neurological disorder or dementia with acute/marked mental status change, or for a second opinion/diagnostic clarification.
- An E/M service may substitute for the initial psychiatric diagnostic interview if all required elements of the E/M billed are fulfilled, including provision of a written opinion and/or advice.
9 Active Policies
A57480, Billing and Coding: Psychiatry and Psychology Services
J5
WPS-L34616, Psychiatry and Psychology Services
J8
FIRST_COAST-L33252, Psychiatric Diagnostic Evaluation and Psychotherapy Services
J9
A57520, Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services
J9
Related Codes
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