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.

Verity

`G0018` — 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); each additional 30 minutes (list separately in addition to code for primary service)

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

2.25

Facility

$83.17

Non-Facility

$105.21

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.

When reporting both E/M and psychotherapy on the same date, documentation must demonstrate the two services were significant and separately identifiable; a separate diagnosis is not required.

E/M services used as the initial psychiatric diagnostic interview must include documentation of the required E/M elements and the provision of a written opinion and/or advice.

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.

8 Active Policies

L34616 — Psychiatry and Psychology Services

J05

A57480 — Billing and Coding: Psychiatry and Psychology Services

J05

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

J09

L33252 — Psychiatric Diagnostic Evaluation and Psychotherapy Services

J09

A57130 — Billing and Coding: Psychiatric Codes

J12

L35101 — Psychiatric Codes

J12

A59723 — Billing and Coding: Outpatient Psychotherapy

L39853 — Outpatient Psychotherapy

Have a follow-up question?

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

G0018 — 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); each additional 30 minutes (list separately in addition to code for primary service)