G0556 Description, Billing Rules, & Use Cases

G0556 supports Medicare’s Collaborative Care Model (CoCM) for behavioral health integration. To bill this code, providers must meet a detailed set of clinical and operational criteria focused on team-based psychiatric care delivery.

Patient Eligibility Criteria

To bill G0556, the patient must:

• Be a Medicare Part B beneficiary
• Have a diagnosed or suspected behavioral health condition, such as:
  • Major depressive disorder (MDD)
  • Generalized anxiety disorder (GAD)
  • Substance use disorder
  • PTSD, panic disorder, or similar
• Have not opted out of behavioral health services
• Provide verbal or written consent for CoCM (must be documented)

Who May Bill G0556

The following providers may submit claims for G0556:

• Physicians (MD/DO)
• Nurse practitioners (NPs)
• Physician assistants (PAs)
• Clinical nurse specialists (CNSs)

The billing provider must:

• Initiate and oversee the CoCM episode
• Supervise the Behavioral Health Care Manager (BHCM)
• Participate in team-based treatment planning
• Personally bill under their NPI

The BHCM and psychiatric consultant cannot bill separately for CoCM services.

CoCM Team Structure (Required)

1. Billing Provider–MD/DO, NP, PA, CNS
2. Behavioral Health Care Manager (BHCM)–delivers the bulk of the care (e.g., LCSW, RN, psychologist)
3. Psychiatric Consultant–advises on medication and care planning (e.g., psychiatrist, clinical psychologist)

Minimum Service Requirements

• Care must include ≥20 minutes of BHCM services in a calendar month
• BHCM must work under general supervision of the billing provider
• Regular caseload consultation with psychiatric consultant is required
• Must use validated measurement tools (e.g., PHQ-9, GAD-7)
• Must document:
  • Time spent
  • Progress toward goals
  • Modifications to treatment plan
  • Team communications

G0556 Billing Documentation Checklist

To bill G0556 compliantly, providers must document all required service elements and team interactions during the month. Below is a checklist covering Medicare expectations for CoCM billing.

Patient eligibility and clinical need:

• Patient is enrolled in Medicare Part B
• Diagnosed or suspected behavioral health condition documented
• Medical record shows clinical rationale for CoCM initiation

Informed patient consent:

• Verbal or written consent to participate in CoCM
• Consent includes acknowledgment of potential cost sharing
• Consent date and details recorded in the chart

Care team structure clearly defined:

• Name and role of:
  • Billing practitioner
  • Behavioral Health Care Manager (BHCM)
  • Psychiatric consultant
• Supervision relationship documented

Minimum time met and recorded:

• At least 20 minutes of BHCM time during the calendar month
• Time logs may be cumulative but must reflect:
  • Direct patient interactions
  • Care plan review and updates
  • Coordination with psychiatric consultant
  • Patient education and symptom tracking

Measurement-based care tools used:

• Examples include PHQ-9, GAD-7, AUDIT-C, etc.
• Scores recorded with interpretation
• Tool selection matches diagnosis and treatment plan

Caseload consultation with psychiatric consultant:

• Regular case review documented (group or 1:1 format)
• Psychiatric input noted in patient record or care plan updates

Behavioral health care plan documented and updated:

• Patient-specific goals and interventions
• Treatment response tracked
• Adjustments to care or medications noted
• Plan shared with patient or caregiver if appropriate

Communication and care coordination:

• BHCM-patient interactions documented (calls, messages, sessions)
• Progress notes or care summaries shared with the billing provider
• Communication with external providers recorded (if applicable)