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G0556
Description, Billing Rules, and Use Cases

HCPCS G0556 is used to bill for the monthly care management services provided by a designated Behavioral Health Care Manager (BHCM) as part of Medicare’s Psychiatric Collaborative Care Model (CoCM).

 

It covers structured behavioral health interventions, psychiatric consultation, and ongoing care coordination under the supervision of a billing provider.

What is HCPCS Code G0556?

G0556 represents the primary billing code for psychiatric CoCM services during a calendar month. It is intended for use in outpatient and primary care settings where a BHCM is integrated into the care team, working in consultation with a psychiatric consultant and under the direction of a treating physician or qualified healthcare professional.

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To qualify for G0556, the care must involve:

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  • A designated BHCM, such as a social worker, RN, or other mental health professional

  • Psychiatric oversight from a psychiatrist or clinical psychologist

  • Structured, measurement-based care (e.g., PHQ-9)

  • A documented CoCM care plan with patient-centered goals

  • Regular caseload reviews and team coordination

  • A minimum of 20 minutes of BHCM activities per month

  • Use of validated tools and continuous symptom monitoring

 

G0556 is billed once per calendar month, and is often paired with add-on codes G0557 and G0558 for extended BHCM time.

G0556 Billing Requirements and Eligibility

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:

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  • 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:

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  • Physicians (MD/DO)

  • Nurse practitioners (NPs)

  • Physician assistants (PAs)

  • Clinical nurse specialists (CNSs)

 

The billing provider must:

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  • 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.

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  • 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)

G0556 Time Thresholds and Code Combinations

G0556 is billed once per calendar month when at least 20 minutes of Behavioral Health Care Manager (BHCM) activity has occurred under the Collaborative Care Model (CoCM). If more time is spent delivering CoCM services, add-on codes G0557 and G0558 may be reported.

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Use the following chart to determine the correct billing combination:

Table outlining G0556 billing thresholds with G0557 and G0558 time-based add-ons under the Collaborative Care Model.

Key Reminders:

  • Time is cumulative across the calendar month

  • Only direct BHCM service time qualifies (not billing provider or psychiatrist time)

  • Must track time precisely — do not round up

  • G0556 must be billed before any add-on codes can be used

  • G0557 and G0558 can be stacked in 30-minute blocks

When to Use G0556:
Common Scenarios and Use Cases

G0556 is billed once per calendar month when a Behavioral Health Care Manager (BHCM) provides at least 20 minutes of care coordination, behavioral health support, and psychiatric collaboration as part of the Collaborative Care Model (CoCM).

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Here are examples of how G0556 is used in practice:

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  • Behavioral Health Integration for Mild Depression in Primary Care
    A licensed clinical social worker (BHCM) under physician supervision:

    • Administers the PHQ-9 and confirms mild depressive symptoms

    • Coordinates follow-up with PCP and patient education session

    • Discusses case with psychiatric consultant to adjust medication
      Total BHCM time: 28 minutes
      Billing: G0556

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  • Extended CoCM for Generalized Anxiety With Medication Changes
    An RN care manager (BHCM) under NP supervision:

    • Tracks GAD-7 progress scores and patient adherence

    • Reviews treatment plan with a consulting psychiatrist

    • Provides multiple check-ins for new medication side effects
      Total BHCM time: 65 minutes
      Billing: G0556 + G0557

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  • Complex PTSD Support With Escalating Risk Factors
    A behavioral health coach (BHCM) under PA supervision:

    • Coordinates trauma-informed therapy referral

    • Conducts 3 follow-up calls and supports a crisis intervention plan

    • Collaborates closely with psychiatrist on treatment update
      Total BHCM time: 94 minutes
      Billing: G0556 + G0557 + G0558

Common G0556 Billing Mistakes
(and How to Avoid Them)

As part of Medicare’s Collaborative Care Model (CoCM), G0556 has unique billing conditions. The most common errors involve unqualified time, incomplete documentation, or improper team setup.

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❌ Billing G0556 With Less Than 20 Minutes of BHCM Time
G0556 requires a minimum of 20 minutes of time from the Behavioral Health Care Manager (BHCM). Rounding up or including administrative time risks denial.

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❌ No Documented Psychiatric Consultant Involvement
The CoCM model requires consultation with a psychiatrist or clinical psychologist. If this step is missing or undocumented, the claim may not meet CoCM standards.

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❌ BHCM or Psychiatric Consultant Submitting Their Own Claim
Only the billing provider (MD/NP/PA/CNS) may submit G0556. Time spent by BHCM or consultants must be billed under the billing provider’s NPI — not separately.

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❌ Inadequate Care Plan Documentation
G0556 billing requires a CoCM-specific care plan, including:

  • Patient-centered goals

  • Measurable outcomes

  • Updates based on symptom scores
    Missing this plan (or failing to update it) may lead to retraction during audit.

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❌ Using G0557 or G0558 Without G0556
Add-on codes G0557 and G0558 must follow G0556. Billing these without the base code violates CMS structure and will be rejected.

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