Does G0409 require prior authorization?

No, G0409 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0409?

Medicare facility rate: $24.05. Non-facility rate: $24.05. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$24.05

Non-Facility

$24.05

Document time spent in the psychotherapy encounter, including face-to-face time (with explicit face-to-face time documented for sessions >90 minutes).
Document therapeutic interventions used (eg, behavioral modification, supportive interaction, interpretive interactions) and the degree of patient interaction and participation.
Provide periodic summaries of goals and progress toward goals and update treatment plans generally every three months to include estimated duration, treatment goals, targeted symptoms, and treatment-related behavioral changes, processes, or medications.
Document presence of a psychiatric illness and/or emotional or behavioral symptoms sufficient to alter baseline functioning.

Individual psychotherapy CPT codes 90832, 90834, and 90837 are covered when the primary focus of treatment is individual psychotherapy.
Psychotherapy with medical management add-on codes 90833, 90836, and 90838 are allowed when psychotherapy is provided in addition to a documented E/M service.
Family psychotherapy codes 90846 and 90847 are covered for family psychotherapy sessions.
Group psychotherapy code 90853 is covered when group therapy is medically necessary; interactive complexity (90785) may be billed with 90853 when criteria met.
Crisis psychotherapy codes 90839 (first 60 minutes) and 90840 (each additional 30 minutes) are covered as standalone crisis services, with 90840 required to be billed with 90839.
Interactive complexity add-on code 90785 may be reported when communication difficulties (eg, caregiver emotion interfering, maladaptive communication, language barriers, involvement of third party, reporting to third party) occur during an eligible psychiatric procedure and when billed with allowed psychiatric procedure codes.

PALMETTO-JJ-L39853, Outpatient Psychotherapy

PALMETTO-JM-L39853, Outpatient Psychotherapy

A59723, Billing and Coding: Outpatient Psychotherapy

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