CMS RVU26D · Effective 2026-10-01
Report G0323 for monthly behavioral health care management when at least 20 minutes of qualifying clinical staff time are provided under a qualified professional’s direction. Compare G0323 office and facility rates across CMS payment localities in Virginia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
$56.96–$64.13
2 of 2 localities have a supported rate.
$37.26–$40.52
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Behavioral health
Report G0323 for monthly behavioral health care management when at least 20 minutes of qualifying clinical staff time are provided under a qualified professional’s direction.
G0323 covers monthly care management for a patient with a behavioral health condition, rather than a single psychotherapy session. Clinical psychologists and clinical social workers may use this Medicare pathway for behavioral health integration; clinical staff perform the care management under the direction of a physician or other qualified health care professional. Work can include coordinating behavioral health care with the patient’s primary care team, monitoring progress, and following up on the treatment plan.
Report one unit for a calendar month in which the required 20 minutes of qualifying clinical staff time are met. Document the behavioral health condition, care-management activities, time accumulated during the month, and the directing professional. The record should show ongoing care coordination or follow-up, not simply a referral or an individual therapy encounter. G0323 is a monthly service, so it is not selected by the length of one office visit.
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This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Office rates for Virginia, from the same CMS release.
Both are monthly behavioral health integration services with a 20-minute threshold. G0323 is the Medicare pathway associated with clinical psychologists and clinical social workers; use 99484 when its practitioner and service requirements fit.
99492 describes initial-month psychiatric collaborative care management, with a defined collaborative care model and team structure. G0323 is a general behavioral health care-management pathway, not that model-specific service.
99493 is for a subsequent month of psychiatric collaborative care management under the collaborative care model. G0323 reports monthly behavioral health care management outside that model-specific distinction.
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Office / nonfacility
$64.13
Facility
$40.52
Office / nonfacility
$56.96
Facility
$37.26
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No. It represents monthly behavioral health care management, such as care coordination and treatment-plan follow-up, not the time spent conducting an individual psychotherapy session.
Document at least 20 minutes of qualifying clinical staff time during the calendar month. The code is reported for the month, not per visit.
Medicare established this pathway for clinical psychologists and clinical social workers providing behavioral health integration. The care-management work is directed by a physician or other qualified health care professional.
Both describe monthly behavioral health integration with a 20-minute time threshold. G0323 is the Medicare pathway associated with clinical psychologists and clinical social workers; apply the relevant practitioner and service requirements when choosing between them.
A referral by itself does not establish monthly care management. Document the qualifying coordination, monitoring, or follow-up work and the time provided during the month.
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
