Get Up to Speed With These Medicare Digital Mental Health Treatment Codes
Understand this latest advance in behavioral health services. The 2025 Medicare Physician Fee Schedule provides new reimbursement opportunities for digital mental health treatment. There is good news for providers who offer digital mental health services (DMHT). The 2025 Medicare Physician Fee Schedule (MPFS) established HCPCS Level II codes G0552-G0554 for DMHT devices and services. Codes G0552-G0554 are reimbursed for DMHT that’s used as part of a behavioral health treatment plan. MPFS payment for these services acknowledges the importance and legitimacy of DMHT to help patients, which may help reduce stigma and encourage more individuals to seek mental and behavioral help when needed. Understand DMHT and What’s Behind the Decision DMHT includes a variety of services such as online therapy sessions, mental health apps, online self-help programs, and telepsychiatry. These services can be accessed via smartphones, computers, or other digital devices designed to provide mental health support to individuals in a more accessible and convenient manner. The digital therapeutics industry has pushed for widespread payer coverage for years, arguing that these businesses aren’t sustainable without a consistent revenue stream. Meet the 3 New Codes The MPFS final rule for calendar year 2025 introduced three new HCPCS Level II codes reimbursed under MPFS for DMHT devices: The goal of these codes is to improve access to behavioral health services, to set a reimbursement precedent for digital therapeutics, and to better integrate behavioral health treatment into primary care and other settings. The relative value units (RVUs) for G0552-G0554 can be found on pages 344-362 of the final rule. G0552 has been assigned “contractor pricing” described in more detail below. According to the final rule, G0552 is payable only if the DMHT device has been cleared under section 510(k) of the FD&C Act or granted De Novo authorization by the U.S. Food and Drug Administration (FDA) as classified under 21 CFR 882.5801 and the provider incurs the cost of furnishing the DMHT device to the patient. To receive payment, DMHT devices must be “furnished incident to professional behavioral health services used in conjunction with ongoing behavioral health treatment under a behavioral health treatment plan of care.” Also, according to the final rule, the billing provider must diagnose the patient and prescribe or order the DMHT device. The patient could then use the DMHT device at home or in an office or another outpatient setting classified by the FDA under 21 CFR 882.5801. The furnished DMHT device must have demonstrated safety and effectiveness by the FDA under 21 CFR 860.7. When determining safety and effectiveness, the FDA considers these factors: G0552 is not payable in cases where the billing provider does not pay for acquiring or furnishing the DMHT device or the patient obtains the DMHT device independent of the provider. Know Who Is Eligible or Authorized to Bill for DMHT The Centers for Medicare & Medicaid Services (CMS) states that DMHT devices may be ordered by a physician or other practitioner and billed when: Watch the Clock and Calendar for G0553 and G0554 HCPCS Level II codes G0553 and G0554 require direct patient or caregiver interaction and are used for ongoing device-based treatment. They allow for monthly billing of DMHT-related treatment management services. G0553 and G0554 should only be billed when there is ongoing use of the DMHT device, and they should not be billed if the patient discontinues the device’s use for DMHT. For G0553, CMS values the first 20 minutes of treatment management services based on a direct crosswalk to CPT® 98980 (Remote therapeutic monitoring treatment management services …), which is assigned a work RVU of .62. The value of G0554 is based on a crosswalk to CPT® +98981 (… each additional 20 minutes (List separately in addition to code for primary procedure), which is assigned the same work RVU of .61. The work in HCPCS Level II codes G0553 and G0554 is compared to the work described in the CPT® code crosswalks because they include similar physician or other qualified healthcare professional time in a month and require at least one interactive communication with the patient or caregiver during that month. Follow This ACP Advice and Get on Board The new codes represent a giant step toward supporting DMHT providers and accepting new digital technologies that help mental and behavioral health. Many physician associations are happy because CMS addressed their comments and questions during the final rule proposal commenting period. The American College of Physicians (ACP®) said in a commenting letter to CMS: “ACP is pleased that CMS has finalized payment for the three new HCPCS codes, G0552, G0553, and G0554, for DMHT devices. We are hopeful that this will enable primary care physicians to continue providing behavioral health services for patients, as the demand for these services continues to rise and inability to access mental health services remains a barrier to receiving care. The College also thanks CMS for addressing patient privacy and cybersecurity concerns with these devices and outlining the cybersecurity steps required for FDA approval.” The wins for acceptance and reimbursement of DMHT services can lead to cost savings by reducing the need for in-person visits and the time healthcare providers spend on routine monitoring is minimized. Patients will be more likely to adhere to treatment plans in the comforts of their own home. DMHT may also reduce long-term costs associated with untreated or poorly managed mental health conditions. Michelle A. Dick, BS, Development Editor, AAPC (A version of this article first appeared in the August 2025 issue of AAPC the Magazine)
