Reimbursement
$43.42
Threshold
20m
2026 Status
Active
What is CPT Code G0323?
CPT G0323 is defined as: Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; a person-centered care plan; coordination of care and referrals, and a continuous relationship with an assigned member of the care team.
This code is primarily used for BHI services. It falls under the category of Behavioral Health Integration (BHI) / General and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.61
Physician Effort
PE (Non-Fac)
0.66
Practice Expense
Malpractice
0.03
Risk Factor
Total RVU
1.3
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
independent billing
Allows CP and CSW to be the primary billing entity for care management, separate from physician-led BHI (99484).
efficiency shield
Exempt from the -2.5% efficiency adjustment as it is a time-based management service.
virtual supervision
While CPs/CSWs often work independently, any coordinated activities can utilize virtual direct supervision if applicable.
Administrative Framework
Operational Requirements
minimum time
20 minutes per calendar month
staff type
Clinical Psychologist (CP) or Clinical Social Worker (CSW)
frequency
Once per calendar month
add on codes
care plan requirement
Person-centered care plan including assessment of behavioral health needs and coordination of referrals.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare is expanding the utilization of CP/CSW-led management to address the increasing demand for behavioral health access.
Common Clinical Scenarios
CMS Eligibility: 1 or more behavioral health conditions. Duration of management is based on clinical necessity
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99484
99484 is physician-led; G0323 is for management personally provided by a psychologist or social worker.
VS 90832
9083x codes are for face-to-face psychotherapy sessions; G0323 is for care management and coordination.
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