G0558
Description, Billing Rules, and Use Cases

G0558 is an add-on HCPCS code used under Medicare’s Collaborative Care Model (CoCM) to report each additional 30 minutes of behavioral health services delivered by the Behavioral Health Care Manager (BHCM) after the time billed under G0556 and G0557.

It allows providers to capture extended BHCM time spent on complex or high-need cases, as long as documentation and supervision requirements are met.

What is HCPCS Code G05578?

G0558 represents every additional 30-minute unit of CoCM services beyond the initial 40 minutes covered by G0556 (first 20 min) and G0557 (each additional 20 min). It can be billed multiple times in a calendar month as long as qualifying cumulative time is documented.

Eligible services include:

Extended follow-up and care coordination

Ongoing documentation of behavioral health status and care plan changes

Communication with psychiatric consultants

Measurement-based symptom tracking

Referrals, community resource navigation, and social care coordination

Like other CoCM codes, G0558 may only be submitted by the billing provider (MD, DO, NP, PA, CNS), and must be delivered under general supervision as part of a documented, active CoCM care plan.

G0558 Billing Requirements and Eligibility

G0558 is an add-on code that captures each additional 30 minutes of Behavioral Health Care Manager (BHCM) time under the Collaborative Care Model (CoCM). It follows G0556 and G0557 when total BHCM service time exceeds 60 minutes in a single calendar month.

Patient Eligibility Criteria

Only the billing provider can submit claims for G0558:

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

The BHCM and psychiatric consultant do not bill directly — all time is submitted under the billing provider’s National Provider Identifier (NPI).

Service Requirements

G0558 must meet all of the following criteria:

Stacked on top of G0556 and G0557
- G0558 cannot be billed unless both G0556 and at least one unit of G0557 have been billed
Total BHCM time ≥60 minutes
- First 20 minutes → G0556
- Next 20-minute units → G0557
- Every 30-minute unit beyond that → G0558 × n
Documented CoCM services performed by BHCM
- Extended patient follow-up or monitoring
- Complex symptom assessment and scoring (e.g., PHQ-9, GAD-7)
- Coordination with the psychiatric consultant
- Time-stamped care plan documentation
Delivered under general supervision
- BHCM must work under the direction of the billing provider
- Psychiatric consultant must participate in care review

Patient Eligibility

Medicare beneficiary receiving services under the CoCM model
Has an active CoCM care plan
Has given documented verbal or written consent for CoCM services
Presents with a diagnosed or suspected behavioral health condition

G0558 Billing Documentation Checklist

To compliantly bill G0558, providers must document qualifying BHCM activity and ensure that time thresholds, supervision, and clinical requirements are fully met.

Base codes G0556 and G0557 have already been billed:
- G0558 is an add-on and must follow these in the same calendar month
- Must be clearly linked in the claim and clinical record
Total BHCM time ≥60 minutes:
- G0556: first 20 minutes
- G0557: each additional 20-minute unit
- G0558: each additional 30-minute block beyond 60 minutes
- Each 30-minute increment must be fully met, not rounded
Cumulative time log maintained:
- BHCM-only service time documented by activity (e.g., 15 min call, 10 min care plan update)
- Separate from provider or psychiatric consultant time
- Time must be attributed to CoCM care delivery — not admin tasks
Active CoCM care plan documented:
- Behavioral health diagnosis present (e.g., MDD, PTSD, GAD)
- Plan includes treatment goals, interventions, and outcomes
- Updated in response to symptom monitoring and consultation
Care coordination and psychiatric consultation notes:
- BHCM activities reflect interaction with psychiatric consultant
- Changes to plan, medications, or next steps recorded in chart
- Psychiatric input summarized in patient notes or documentation log
Team structure and supervision evident:
- BHCM name, credentials, and supervising provider identified
- Psychiatric consultant named with role (e.g., MD, clinical psychologist)
- All care occurred under general supervision and within scope

G0558 Time Thresholds and Code Combinations

G0558 is used to report each additional 30-minute increment of Behavioral Health Care Manager (BHCM) time after the first 60 minutes of CoCM services in a calendar month. It must follow G0556 and at least one G0557, and may be billed multiple times as long as full time blocks are documented.

Use the following chart to determine the correct billing combination:

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

Key Reminders:

G0558 is not standalone — it must follow both G0556 and G0557
Time is cumulative across the calendar month
Time must be direct BHCM activity, not provider or consultant time
Each G0558 unit = an additional 30 minutes fully met
Stacking is allowed (G0558 ×2, ×3, etc.) as time increases

When to Use G0558:
Common Scenarios and Use Cases

G0558 should be billed when BHCM time exceeds 60 minutes in a calendar month and additional 30-minute blocks of service are delivered. This code supports extended care coordination, follow-up, and consultation under the Collaborative Care Model (CoCM), especially for patients with complex behavioral health needs.

Multi-Modal Support for Severe Depression and Social Isolation
A licensed clinical social worker (BHCM) under MD supervision:
- Coordinates housing support and community mental health referrals
- Tracks patient PHQ-9 progress over four contacts
- Updates care plan and consults psychiatrist on medication resistance
  Total BHCM time: 95 minutes
  Billing: G0556 + G0557 + G0558

Intensive Case Management With Co-Occurring PTSD and SUD
An RN behavioral health manager under NP supervision:
- Works with both mental health and addiction treatment teams
- Provides regular coaching to reduce relapse risk
- Adjusts care goals after psychiatric case review
  Total BHCM time: 122 minutes
  Billing: G0556 + G0557 + G0558 ×2

High-Frequency Follow-Up for GAD With Cognitive Impairment
A BHCM coach under PA supervision:
- Completes multiple home and phone visits across the month
- Uses GAD-7 to guide treatment and reviews response with psychiatrist
- Coordinates with caregiver to modify care goals
  Total BHCM time: 147 minutes
  Billing: G0556 + G0557 + G0558 ×3

Common G0558 Billing Mistakes
(and How to Avoid Them)

G0558 enables extended billing under the CoCM model, but only when clearly documented and properly stacked with G0556 and G0557. Below are the most common mistakes practices make.

❌ Billing G0558 Without G0556 and G0557
G0558 is an add-on code that must follow both G0556 and at least one unit of G0557. Submitting it on its own — or before the others — will result in a denial.

❌ Including Provider or Psychiatric Consultant Time
Only Behavioral Health Care Manager (BHCM) time counts toward the thresholds. Time spent by physicians, NPs, or psychiatric consultants does not qualify for G0558.

❌ Under-documenting Total Time
Each unit of G0558 represents 30 full minutes of BHCM time. If only 25 minutes are performed, the code cannot be billed — partial time is not allowed.

❌ Rounding Up to Meet Time Thresholds
G0558 requires exact documentation of time met. Avoid rounding logs or aggregating unclear minutes just to qualify for a new billing tier.

❌ Stacking Too Aggressively Without Evidence of Complexity
While you can bill multiple G0558 units, each must be clearly supported by documentation of patient need, service activity, and care team communication.

G0558 Description, Billing Rules, and Use Cases