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HCPCS G0323 · Level II · G code

G0323: Care management services for behavioral health conditions, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0323

Medicare payment
$57.78
PFS non-facility, national; facility $37.74
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
0
0 hospital outpatient
LCDs and articles
1 / 1

TL;DR

HCPCS Level II G0323 reads "Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)" in the October 2026 file; it dates from 2023. Under the 2026 physician fee schedule (October release) G0323 carries 0.93 work, 0.76 practice-expense and 0.04 malpractice RVUs, which at $33.4009 per RVU pays $57.78 non-facility and $37.74 facility before the locality adjustment. Qualifying APM participants get $58.07 at $33.5675. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). 1 active LCD and 1 billing and coding article list G0323 across 4 states: L39853 (Outpatient Psychotherapy), A59723. HCPCS record: BETOS Z2 (not assigned to a BETOS category); pricing indicator 13; type of service 1 (medical care). 1 other active code opens with "Care management services for behavioral health conditions"; related codes: G0570, G0327, G0318, G0328.

G0323 descriptor and code status

The October 2026 HCPCS Level II file describes G0323 as “Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0323 CPT code", G0323 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0323
FieldValue
Short descriptorCare manage beh svs 20mins
Added to HCPCS2023-01-01
Last actionN (no maintenance), effective 2024-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryZ2: not assigned to a BETOS category
Type of service1: medical care

Medicare payment for G0323

Under the 2026 physician fee schedule (October release) G0323 carries 0.93 work, 0.76 practice-expense and 0.04 malpractice RVUs, which at $33.4009 per RVU pays $57.78 non-facility and $37.74 facility before the locality adjustment. Qualifying APM participants get $58.07 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0323
ComponentNon-facilityFacility
Work RVU0.930.93
Practice expense RVU0.760.16
Malpractice RVU0.040.04
Total RVUs1.731.13
National payment (CF $33.4009)$57.78$37.74
Qualifying APM participant (CF $33.5675)$58.07$37.93
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator S (Procedure or service, not discounted when multiple), APC 5821 (Level 1 Health and Behavior Services), national unadjusted payment $38.28 with a minimum unadjusted copayment of $7.66.

Medically Unlikely Edits for G0323

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0323 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0323 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0323 in v323r0.

G0323 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0323 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0323

1 active Local Coverage Determination and 1 billing and coding article list G0323. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0323
ArticleTitleContractor(s)Related LCD
A59723Billing and Coding: Outpatient PsychotherapyPalmetto GBAL39853

Denials to expect on G0323

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0323

CARC 151 · N362

units of G0323 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0323 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0323 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0323

What does HCPCS code G0323 describe?

"Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)" (short descriptor "Care manage beh svs 20mins"), in the G section (procedures and professional services, temporary). Added 2023-01-01; last action N (no maintenance) effective 2024-01-01.

Is G0323 a CPT code?

No. G0323 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0323 CPT code" mean this Level II code.

What does Medicare pay for G0323?

Under the 2026 physician fee schedule (October release) G0323 carries 0.93 work, 0.76 practice-expense and 0.04 malpractice RVUs, which at $33.4009 per RVU pays $57.78 non-facility and $37.74 facility before the locality adjustment. Qualifying APM participants get $58.07 at $33.5675.

How many units of G0323 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0323?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list G0323 across 4 states: L39853 (Outpatient Psychotherapy), A59723.

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.