G0557 Description, Billing Rules, & Use Cases

HCPCS G0557 is an add-on billing code used to report each additional 20 minutes of behavioral health care management under the Medicare Collaborative Care Model (CoCM). It must be reported with G0556, the primary code for the first 20 minutes, and cannot be billed alone.

G0557 represents cumulative time spent by the Behavioral Health Care Manager (BHCM) under physician or qualified healthcare provider supervision.

What is HCPCS Code G0557?

G0557 is a CoCM add-on code that allows Medicare billing for behavioral health services after the initial 20 minutes (captured under G0556) have been exceeded in a given calendar month. This code is billed per additional 20-minute increment of qualifying care activities performed by the BHCM, such as:

Care coordination with the psychiatric consultant
Ongoing patient support and symptom tracking
Behavioral health coaching
Documentation updates to the CoCM care plan
Communication with family, specialists, or community support services

To meet G0557 billing standards, all care must be supervised by the billing provider, and the patient must have an active CoCM care plan in place. Like G0556, patient consent must be documented, and cumulative time must be clearly tracked in the patient record.

G04556 Time Thresholds and Code Combinations

G0557 is an add-on code used for each additional 20 minutes of Behavioral Health Care Manager (BHCM) services delivered after the initial 20 minutes (covered by G0556). This time is cumulative across the calendar month, and must be carefully documented.

Important to Note:

G0557 cannot be billed alone — it must follow G0556
Time must reflect BHCM-only activities (not billing provider or psychiatric consultant)
If ≥60 minutes of total BHCM time is documented, additional units of G0558 may be used
All services must occur under general supervision

Table showing how G0557 stacks with G0556 and G0558 based on total monthly BHCM time in the Collaborative Care Model.

When to Use G0557: Common Scenarios and Use Cases

G0557 should be billed when a Behavioral Health Care Manager (BHCM) delivers at least 40 cumulative minutes of CoCM services in a calendar month. This includes patient follow-up, care coordination, measurement-based assessments, and consultation with a psychiatric provider — all under the supervision of the billing clinician.

BHCM Complex Medication Adjustment for Anxiety

Ongoing Behavioral Health Monitoring

Multi-Issue Behavioral Support With Peer Navigation

BHCM Complex Medication Adjustment for Anxiety

An RN care manager (BHCM) under MD supervision:

Coordinates psychiatric consultant feedback on medication trial
Schedules a behavioral therapy referral
Documents symptom score changes (GAD-7) and care plan updates

Total BHCM time: 46 minutes
Billing: G0556 + G0557

Senior woman reviewing care plan with male physician during medical consultation, illustrating shared decision-making and chronic condition management in primary care

Ongoing Behavioral Health Monitoring

A licensed clinical social worker (BHCM) under NP supervision:

Provides education and self-monitoring tools for depression
Conducts two check-in calls to address adherence issues
Communicates care updates with the billing NP and family caregiver

Total BHCM time: 54 minutes
Billing: G0556 + G0557

Patient using tablet for virtual consultation with female doctor, illustrating telehealth services, remote care delivery, and digital patient engagement

Multi-Issue Behavioral Support With Peer Navigation

A certified behavioral health coach (BHCM) under PA supervision:

Assists with insurance re-enrollment and social service referrals
Supports anxiety symptom tracking and lifestyle coaching
Coordinates with a psychiatrist regarding care plan revision

Total BHCM time: 58 minutes
Billing: G0556 + G0557

Social worker providing emotional support and counseling to distressed young woman, highlighting psychosocial care, case management, and behavioral health intervention with community health integration

G0557 Billing Requirements and Eligibility

G0557 is an add-on code that supports extended billing under the Medicare Collaborative Care Model (CoCM). It must be billed in conjunction with G0556, the primary monthly code, and reflects each additional 20 minutes of qualifying care delivered by the Behavioral Health Care Manager (BHCM).

Patient Eligibility Criteria

Medicare Part B beneficiary
Has a diagnosed or suspected behavioral health condition
Has provided documented consent for CoCM
Must be actively engaged in CoCM care during the billed month

G0557 cannot be billed as a standalone code, and is not valid without G0556 as the base. Time must reflect BHCM efforts only, not billing provider or psychiatrist activity.

Who May Bill G0557

Only the billing provider may submit claims for G0557:

The BHCM and psychiatric consultant do not bill separately — all time is submitted under the supervising provider’s NPI.

Service Requirements

To bill G0557, the following must be true:

G0556 has already been met and billed in the same calendar month
BHCM has delivered ≥40 minutes of cumulative services
Services are provided under general supervision of the billing provider
The patient has an active CoCM care plan
Time logs are documented, including:
Patient communication
Coordination with psychiatric consultant
Measurement-based care (e.g., PHQ-9, GAD-7)
Care plan review or adjustment
External provider communication or family updates

G0557 Billing Documentation Checklist

To compliantly bill G0557, all of the following documentation must appear in the patient’s record for the calendar month in which services occurred:

Base CoCM code (G0556) also billed:
- G0557 is an add-on and must follow a valid G0556 claim
- Cannot be submitted on its own
Total BHCM service time ≥40 minutes:
- First 20 minutes covered by G0556
- Each G0557 unit adds 20 additional minutes
- Cumulative BHCM time must be recorded (e.g., time logs or encounter summaries)
Clear time attribution to BHCM activities:
- Direct patient communication (phone, video, in-person)
- Documentation updates and care plan tracking
- Coordination with the psychiatric consultant
- Use of validated assessment tools (PHQ-9, GAD-7, etc.)
- External provider or family communication (as appropriate)
Active CoCM care plan:
- Personalized behavioral health care plan on file
- Goals, interventions, and measurable outcomes listed
- Plan revised during the month if needed
Behavioral health condition documented:
- Condition addressed must be clearly stated (e.g., depression, PTSD, anxiety)
- Progress notes should link service time to treatment needs
Supervision and team structure confirmed:
- BHCM name, role, and supervising provider noted
- Psychiatric consultant available and engaged in case reviews
- Billing provider oversight indicated in record

Common G0556 Billing Mistakes (and How to Avoid Them)

❌ Billing G0557 Without G0556

G0557 is not a standalone code. It must be billed in the same calendar month as G0556 or the claim will be denied.

❌ Billing G0557 With Less Than 40 Minutes of BHCM Time

You must document at least 40 cumulative minutes of time provided by the Behavioral Health Care Manager (BHCM) to justify one unit of G0557.

❌ Including Non-BHCM Time in the 40-Minute Threshold

Only BHCM-delivered services count toward the time requirement. Do not include time from:

The billing provider
Psychiatric consultant
Administrative staff

❌ Failing to Track BHCM Time Separately

G0557 requires clear documentation of BHCM time blocks (e.g., 15 min call, 10 min care plan update, etc.). CMS expects this to be explicitly logged in the record.

❌ Omitting Evidence of Psychiatric Consultation or Plan Updates

Even though G0557 reflects additional BHCM time, you must still show:

Ongoing collaboration with the psychiatric consultant
Active management of a behavioral health care plan
Symptom scores or progress monitoring (e.g., PHQ-9, GAD-7)