G0409 HCPCS code: Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
G0409 is the HCPCS Level II code for social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf). In 2024 Medicare paid an average of $17.28 per service for G0409 across 13 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 4 per day on outpatient hospital claims. Medicare volume fell 55% from 2022 to 2024 (29 to 13 services). In 2024, about 11 clinicians billed Medicare for G0409 for 13 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 13 |
| BETOS category | M5D |
| Added | 2009-01-01 |
| Last action effective | 2009-01-01 |
Who bills G0409 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 11 |
| Medicare beneficiaries | 13 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0409, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 29 | 29 | $10.61 | $5.85 |
| 2024 | 13 | 13 | $23.84 | $17.28 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Nature of Service/Procedure |
| practitioner claims | 4 | Nature of Service/Procedure |
Medicare policy articles for this code
- A59723: Billing and Coding: Outpatient Psychotherapy (Palmetto GBA (MAC - Part A, MAC - Part B))
- A59723: Billing and Coding: Outpatient Psychotherapy (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (428 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| F01.A0 | Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 1 |
| F01.A11 | Vascular dementia, mild, with agitation | 1 |
| F01.A18 | Vascular dementia, mild, with other behavioral disturbance | 1 |
| F01.A2 | Vascular dementia, mild, with psychotic disturbance | 1 |
| F01.A3 | Vascular dementia, mild, with mood disturbance | 1 |
| F01.A4 | Vascular dementia, mild, with anxiety | 1 |
| F01.B0 | Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 1 |
| F01.B11 | Vascular dementia, moderate, with agitation | 1 |
| F01.B18 | Vascular dementia, moderate, with other behavioral disturbance | 1 |
| F01.B2 | Vascular dementia, moderate, with psychotic disturbance | 1 |
Showing 10 of 428. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for G0409
- 2009-01-01: G0409 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0409?
G0409 is the HCPCS Level II code for social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf). Short descriptor: "Corf related serv 15 mins ea".
How much does Medicare pay for G0409?
In 2024, the average Medicare payment was $17.28 per service (average allowed $23.84).
Does Medicare cover G0409?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for G0409?
Medicare policy articles that cite G0409 list 428 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include F01.A0 (Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety), F01.A11 (Vascular dementia, mild, with agitation), F01.A18 (Vascular dementia, mild, with other behavioral disturbance). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of G0409 can be billed per day?
4 on outpatient hospital claims; 4 on practitioner claims (NCCI medically unlikely edits).
Related G04 codes
- G0400 — Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
- G0402 — Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
- G0403 — Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
- G0404 — Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
- G0405 — Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
- G0406 — Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
- G0407 — Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
- G0408 — Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
- G0410 — Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0411 — Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0412 — Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
- G0413 — Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)
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Next steps
- Run a reimbursement report for a device billed under G0409
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Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.