Question 1

What is HCPCS code G0507?

Accepted Answer

HCPCS code G0507 is "Care manage serv minimum 20". Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team

Question 2

What category is G0507 in?

Accepted Answer

G0507 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0507?

Accepted Answer

Use G0507 when billing for care manage serv minimum 20. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0507 covered by Medicare?

Accepted Answer

Coverage for G0507 (Care manage serv minimum 20) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0507?

Accepted Answer

Documentation for G0507 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).