Article
CMS Medicare reimbursement updates to impact behavioral health services
Feb. 12, 2025 · Authored by Marisol Cooke, Kim Hodson
The Centers for Medicare & Medicaid Services (CMS) made significant changes to Medicare reimbursement policies for behavioral health services, which are set to take effect in 2025.
These updates are part of a broader effort to improve access to high-quality mental healthcare and integrate behavioral and physical health services.
Key updates to Medicare reimbursement policies
Major updates are as follows.
New billing codes for safety planning (Code G0560)
Safety planning interventions are services provided to individuals who are experiencing crises such as suicidal ideation or risk of overdose. These services can be provided via telehealth and is billed in 20-minute increments.
Coverage for digital mental health tools
Medicare will cover FDA-approved digital mental health devices. Similar in structure and documentation requirements to the remote patient monitoring codes, these services will require an order for the FDA device, documentation of training provided to the individual, and the time and work associated with monthly treatments. (Codes G0552–G0554)
Keep in mind that to bill for the supply of the digital mental health tool (Code G0552), the billing practitioner must have incurred the expense.
Expanded billing for interprofessional consultations for practitioners
This includes clinical psychologists, clinical social workers, and other practitioners that are limited to treatment of mental illness. Codes G0546–G0551 describing these services are available for reporting to CMS.
Network adequacy requirements for Medicare Advantage plans
Medicare Advantage plans must maintain adequate networks of outpatient behavioral health providers. This ensures beneficiaries have access to in-network services, reducing out-of-pocket costs and wait times.
Provisional coverage for behavior management and modification training delivered to caregivers of an individual patient
Codes G0539 and G0540 can be used to report caregiver training related to behavior management and modification for patients with dementia or Alzheimer’s.
