Does G2214 require prior authorization?

No, G2214 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G2214?

Medicare facility rate: $33.73. Non-facility rate: $60.79. Work RVU: 0.77.

Verity

`G2214` — Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional

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.

Medical record must document that biopsychosocial factors are significantly affecting treatment or medical management.

Medical record must document that the patient is alert, oriented, and has the capacity to understand and respond meaningfully during a face-to-face encounter.

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.

2 Active Policies

A56562 — Billing and Coding: Health and Behavior Assessment/Intervention

L37638 — Health and Behavior Assessment/Intervention

Have a follow-up question?

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

G2214 — Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional