Does G0018 require prior authorization?

No, G0018 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0018?

Medicare facility rate: $83.17. Non-facility rate: $105.21. Work RVU: 2.25.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.25

Facility

$83.17

Non-Facility

$105.21

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.

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.

A57480, Billing and Coding: Psychiatry and Psychology Services

WPS-L34616, Psychiatry and Psychology Services

FIRST_COAST-L33252, Psychiatric Diagnostic Evaluation and Psychotherapy Services

A57520, Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services

Ask Verity about documentation requirements, denial risks, or coverage in your state.