Does G0560 require prior authorization?

No, G0560 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0560?

Medicare facility rate: $39.41. Non-facility rate: $42.42. Work RVU: 1.09.

Verity

`G0560` — Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

1.09

Facility

$39.41

Non-Facility

$42.42

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.

All services must be documented in the patient's medical record with legible patient identification (e.g., full name, dates of service) and the legible signature of the responsible physician or NPP.

The submitted medical record must support the selected ICD-10-CM diagnosis code(s) and the CPT/HCPCS code billed; the CPT/HCPCS must accurately describe the service performed.

When time is relevant for coding/payment, document psychotherapy and interactive complexity time with start and stop times or total time; for psychotherapy with E/M, document psychotherapy time separately from E/M time.

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.
Psychotherapy for crisis (CPT 90839, 90840, HCPCS G0017, G0018) is covered when reporting the total face-to-face duration of crisis psychotherapy provided to the patient and/or family, with the patient present for all or some of the service and the clinician devoting full attention to that patient.
When a psychiatric diagnostic evaluation with medical assessment is performed, bill CPT 90792 or an appropriate Evaluation & Management (E/M) code (e.g., 99202-99255, 99304-99310, 99341-99350) to reflect the medical assessment.
If a patient referred with an organic diagnosis is found to have a mental health diagnosis, bill the established mental health diagnosis rather than the referring organic diagnosis.

4 Active Policies

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

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