Revenue Cycle Insider

It’s time to update your coding arsenal for 2025!

G codes are utilized for the purpose of quality reporting and for introducing new services or billing concepts by Centers for Medicare & Medicaid Services (CMS).

In short, HCPCS Level II codes help practitioners who offer services to Medicare, Medicaid, and other third-party insurance beneficiaries receive compensation for services that aren’t encompassed by CPT^® codes.

Read on to learn more about important new G codes coming your way beginning on January 1, 2025.

Check Out These New Telehealth Codes

During the COVID-19 public health emergency (PHE), the Medicare telehealth services expansion allowed many providers to continue to care for their patients virtually. On January 1, providers will have a new set of codes for telehealth visits related to behavioral health fields.

These codes are:

• G0546 (Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 5-10 minutes of medical consultative discussion and review)
• G0547 (…11-20 minutes of medical consultative discussion and review)
• G0548 (…21-30 minutes of medical consultative discussion and review)
• G0549 (… 31 or more minutes of medical consultative discussion and review)
• G0550 (Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a written report to the patient's treating/requesting practitioner, 5 minutes or more of medical consultative time)
• G0551 (Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30 minutes)

Look at the New Caregiver Training Codes

Also new in 2025, the following caregiver training HCPCS codes will serve to record and charge for the educational services given to caregivers. This training could encompass instruction on medication administration, utilization of medical devices, handling patient mobility, and other crucial competencies.

These codes are:

• G0539 (Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes)
• G0540 (Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; each additional 15 minutes)
• G0541 (Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; initial 30 minutes)
• G0542 (Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use G0542 in conjunction with G0541))
• G0543 (Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face with multiple sets of caregivers)

Peruse These Post-Discharge, Infectious Disease Codes

HCPCS will offer coders an opportunity to report post-discharge telehealth visits, as well as visits associated with infectious disease specialists.

These codes are:

• G0544 (Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month)
• G0545 (Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge))

Examine These Recovery Service Codes

Also beginning on January 1, new peer recovery codes will be available for recovery services.

These codes are:

• G0534 (Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
• G0535 (Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
• G0536 (Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code).

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC