G2214, Initial or subsequent psychiatric collaborative care management, first 30
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.77
Facility
$33.73
Non-Facility
$60.79
Documentation Required
- Billing, coding, and documentation must comply with the Local Coverage Determination L37638 referenced by this policy.
- Medical record must document the need for psychological evaluation or intervention to manage the physical illness and ADLs.
- Medical record must document that the assessment is not duplicative of other provider assessments.
- Medical record must document the underlying physical illness or injury.
Key Coverage Criteria
- Health and behavior assessment and intervention services are covered when they meet the coverage criteria and documentation requirements specified in Local Coverage Determination L37638.
- Patient has an underlying physical illness or injury.
- There is documented evidence that biopsychosocial factors are significantly affecting treatment or medical management of the illness or injury.
- Patient is alert, oriented, and has capacity to understand and respond meaningfully during the face-to-face encounter.
- There is a documented need for psychological evaluation or intervention to successfully manage the patient's physical illness and activities of daily living (ADLs).
- The assessment is not duplicative of other provider assessments.
3 Active Policies
PALMETTO-JJ-L37638, Health and Behavior Assessment/Intervention
JJ
PALMETTO-JM-L37638, Health and BehaviorAssessment/Intervention
JM
A56562, Billing and Coding: Health and Behavior Assessment/Intervention
Related Codes
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