HCPCS G0323: Behavioral healthMedicare rate & RVUs in Washington
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.
Medicare pays $59.21–$64.85 for G0323 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What G0323 covers
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.
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.
Where G0323 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $59.21 | $38.11 |
| Seattle (King Cnty) | $64.85 | $40.26 |
How the G0323 rate is calculated
Each of G0323’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0323
RVUs × geographic indexes × conversion factor
Work0.93
0.93 RVUs× 1.000 GPCI
Practice expense0.76
0.76 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
1.7300
Conversion factor
$33.4009
Medicare rate
$57.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0323
G0323 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G0323
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$57.78
- Non-facility (office)
- $57.78
- Facility
- $37.74
Higher because the practice carries its own overhead.
G0323 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99484Behavioral health management
- 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.
- 99492Psychiatric care management
- 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.
- 99493Collaborative care
- 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.
G0323 billing questions
Is G0323 for psychotherapy?
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.
How much time must be documented?
Document at least 20 minutes of qualifying clinical staff time during the calendar month. The code is reported for the month, not per visit.
Who may use G0323?
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.
How does G0323 differ from 99484?
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.
Can G0323 be reported for a referral alone?
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.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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