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BHIBase2026 Compliant

CPT G0568

2026 Billing Guide

BHI with APCM - Initial

Reimbursement

$149.30

Threshold

70m

2026 Status

Active

What is CPT Code G0568?

CPT G0568 is defined as: Behavioral Health Integration services furnished in conjunction with Advanced Primary Care Management (APCM) services, sharing a common care plan; 1st 70 minutes in the 1st calendar month. This code mirrors CPT 99492 (Initial CoCM) for patients enrolled in the APCM program.

This code is primarily used for BHI services. It falls under the category of Behavioral Health Integration (BHI) / CoCM and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.

2026 RVU Components

Relative Value Units (Non-Facility)

Standard Formula Applied

Work RVU

1.88

Physician Effort

PE (Non-Fac)

2.48

Practice Expense

Malpractice

0.11

Risk Factor

Total RVU

4.47

Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor

2026 CMS Policy Intelligence

apcm integration

Specific 'mirror' code created to allow BHI/CoCM billing alongside the new bundled APCM model.

mirror valuation

CMS ensures payment neutrality by matching G0568 valuation exactly to CPT 99492.

efficiency shield

Exempt from the -2.5% efficiency adjustment applied to procedural services in 2026.

Administrative Framework

Place of Service

11 (Office)12 (Home)22 (On Campus-Outpatient Hospital)

NCCI Exclusions

Do not bill with:994929949399484

Key Modifiers

25Significant separately identifiable E/M service (generally not applicable to BHI itself but to base APCM visit).

Required Primary Codes

Must be billed alongside a primary service.

Operational Requirements

minimum time

70 minutes in the first calendar month

staff type

Clinical staff supported by a Psychiatric Consultant and a Care Manager

frequency

Once per patient per first month of BHI service in APCM

add on codes

care plan requirement

Must share a common, integrated care plan with the base APCM service (G0556-G0558).

Compliance Checklist

Documentation of the required 70 minutes of staff time
Evidence of psychiatric consultant involvement (weekly registry review)
Use of validated rating scales (e.g., PHQ-9) for baseline assessment
Verification that BHI and APCM share the same clinical care plan

Audit Defense

No specific audit defense elements defined.

2026 Update

Practices adopting APCM must switch from 99492 to G0568 for their integrated behavioral health claims.

Common Clinical Scenarios

F33.1 (Major depressive disorder, recurrent, moderate) in a patient managed under APCM
F41.0 (Panic disorder) with significant primary care coordination needs

CMS Eligibility: 1 or more behavioral health conditions requiring integrated management. Initial engagement phase of CoCM within an APCM practice

Target Specialties & Utilization

Advanced Primary Care PracticesPatient-Centered Medical Homes (PCMH)

Typical Clinical Indications (ICD-10)

F32.1 (Depression)F41.1 (GAD)F90.9 (ADHD)

Billing Differentiation

VS 99492

99492 is for standard FFS; G0568 is for use only when billing APCM (G0556-G0558).

VS G0569

G0568 is for the FIRST month; G0569 is for subsequent months.

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CPT Code G0568 for BHI with APCM - Initial - 2026 Reimbursement & Rules