Understanding the HCPCS Codes Definition

Determining the right code to use when billing for behavioral health treatment is an essential part of being a mental health clinician who accepts insurance—making familiarity with the HCPCS code’s definition imperative. 

This guide provides a helpful overview of the HCPCS code definition, an explanation of how Level II HCPCS codes differ from CPT codes, and a HCPCS codes list—including each code’s corresponding HCPCS meaning and billing purpose.

What does HCPCS code stand for?

HCPCS is an acronym which stands for Healthcare Common Procedure Coding System. HCPCS codes were created by the Centers for Medicare & Medicaid Services (CMS) and are used as a standardized reporting language relating to medical procedures and services. 

The next section describes the HCPCS meaning, and how it relates to behavioral health, in more detail. 

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What is an HCPCS code?

An HCPCS code classifies medical and diagnostic procedures. According to the CMS, the HCPCS code definition includes two levels of HCPCS codes. 

Level I codes

This level of HCPCS codes are also known as Current Procedural Terminology® codes (CPT or CPT-4 codes). The American Medical Association (AMA) designed CPT codes to describe common professional healthcare services and medical procedures. 

Level II codes

Level II codes are used to record supplies, products, and services, such as medical equipment, orthotics, and prosthetics that aren’t included in CPT codes. Level II codes are maintained by the CMS.

The key difference between HCPCS codes and CPT codes is that HCPCS codes classify medical and diagnostic services for CMS, whereas CPT codes describe healthcare procedures, surgery, and diagnostic services. 

CPT codes are commonly used for billing both public and private insurance plans. 

Behavioral health providers use CPT codes for insurance reimbursement. Even if a clinician doesn't accept insurance, they still need to have an understanding of the HCPCS meaning, as they may be asked by their client to produce a superbill.

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HCPCS code list

Level I HCPCS codes in behavioral health often have to do with behavioral health integration (BHI) services, can only be billed in emergent cases, or may include tests and assessments in service of behavioral health treatment. 

BHI services are typically rendered in conjunction with other health care in rural health clinics, community health programs, treatment facilities, or during hospitalization. 

Here are some examples of HCPCS codes:

HCPCS codeDescriptionNote/Time ruleG0323Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month20+ minutes per monthG0511Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month20+ minutes per month G0155Services of clinical social worker in home health or hospice settings, each 15 minutes15 minutesG0137Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patientsG0017Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes60 minutesH0017Behavioral health; residential (hospital residential treatment program), without room and board, per diemH0002Behavioral health screening to determine eligibility for admission to treatment program

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CPT codes list

The following table provides CPT codes, or Level I HCPCS code examples, that are commonly used by mental health clinicians:

CPT CodeDescriptionNote/Time rule9083230-minute psychotherapy session16 to 37 minutes9083445-minute psychotherapy session38 to 52 minutes90834-9545-minute psychotherapyTelehealth 9084650-minute family therapy session Without client present9083760-minute psychotherapy session53 minutes and over9084760-minute family therapy session With client present9083860-minute psychotherapy with E/M service Therapy session which includes an evaluation and management90791Psychiatric evaluationUsually only one covered per client9083960-minute crisis psychotherapy30 to 74 minutes90853Group psychotherapy Not time-based90875Other psychiatric services or procedures30 minutes of psychophysiological therapy using biofeedback9940460-minute preventive medicine, individual counseling services60 minutes and includes counseling related to subjects appropriate for the patient’s age, history, and areas of concern98968Telephone therapy Conducted by a non-psychiatrist and limited to three hours per client90845PsychoanalysisNot time-based9610160-minute psychological testing Testing, interpretation, and reporting by a psychologist99214Clinical evaluationOutpatient visit for evaluation and management of an existing patient

CPT code modifiers

Behavioral health therapists may add a CPT code modifier when billing a client’s insurance, which provides additional information. 

Common modifiers include:

• Modifier UT: Describes attending to a patient in crisis
• Modifier GT: Defines a telehealth session using audio and video
• Modifier 25: Used to describe a separate evaluation and management service
• NOTE: You can only add modifier 25 to codes 99201 to 99215 and 99341 to 99350.
• Modifier 59: Denotes another service completed with the client on the same day (excludes evaluation and management)
• Modifier 95: Denotes telehealth services

Understanding the HCPCS codes definition can help you confidently run your private practice and deal with insurance and billing—leaving you more time to provide care to your clients.

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