Reimbursement
$135.94
Threshold
60m
2026 Status
Active
What is CPT Code G0569?
CPT G0569 is defined as: Behavioral Health Integration services furnished in conjunction with Advanced Primary Care Management (APCM) services, sharing a common care plan; 1st 60 minutes in a subsequent calendar month. This code mirrors CPT 99493 (Subsequent CoCM) for patients 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)
Work RVU
2.05
Physician Effort
PE (Non-Fac)
1.93
Practice Expense
Malpractice
0.09
Risk Factor
Total RVU
4.07
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
treatment to target incentive
Reflects the 2026 policy of higher wRVU (2.05) for subsequent months to reward active patient management and clinical improvement.
crosswalk consistency
Matches the valuation of CPT 99493 to ensure provider choice of billing model is revenue-neutral.
administrative streamlining
Designed to work within the APCM 'one-check' billing philosophy while capturing intensity.
Administrative Framework
Operational Requirements
minimum time
60 minutes in the subsequent calendar month
staff type
Care Manager directed by Physician/QHP with Psychiatric Consultant
frequency
Once per calendar month (subsequent to initial month)
add on codes
care plan requirement
Continuous management and treatment to target as specified in the integrated APCM care plan.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Practices must ensure their EMR registry is configured to support the slightly different time thresholds between G0568 (70m) and G0569 (60m).
Common Clinical Scenarios
CMS Eligibility: Ongoing management of behavioral health conditions using CoCM model. Duration based on clinical improvement and treatment targets
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99493
G0569 is specifically for the APCM program; 99493 is for traditional FFS.
VS G0568
G0568 is for month 1 (70m); G0569 is for month 2+ (60m).
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