Oct 1998 Table of Contents

Reimbursement Strategies

Medicare Update

Care Plan Oversight: New Codes, Same Old Medicare Policy



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Fam Pract Manag. 1998 Oct;5(9):14-15.

This year's CPT code changes for care plan oversight (CPO) have caused quite a lot of confusion among physicians and their billing staffs. We hope this brief update will help to set the record straight. (For more information on Medicare coverage of CPO, see “Getting Paid for Care Plan Oversight,” FPM, November/December 1995, page 53.)

New codes

Medicare has been making separate payments to physicians for CPO since 1995, but until this year, only two CPO codes existed in CPT. Both codes, 99375 and 99376, described CPO for home-health, hospice and nursing-facility patients. The distinction was that 99375 represented 30 to 60 minutes of CPO in a 30-day period and 99376 represented more than 60 minutes of CPO in a 30-day period.

Now, there are six CPO codes in CPT: two each for home-health (99374–99375), hospice (99377–99378) and nursing-facility patients (99379–99380). Each code reflects the amount of time spent on CPO in a calendar month; and for each pair of codes, the first covers 15 to 29 minutes of CPO in a month, and the second covers 30 minutes or more.

Same old policy

Unfortunately, the coding changes have not altered Medicare's policy regarding CPO:

  • Medicare coverage of CPO is limited to patients receiving Medicare-covered home-health or hospice benefits; don't bill Medicare for CPO provided for nursing-facility patients.

  • Medicare only recognizes 30 minutes or more of CPO within a calendar month; don't bill Medicare for CPO of 15 to 29 minutes.

So despite the additional CPT codes, you're still left with just two you can bill to Medicare for CPO: 99375 (for 30 minutes or more in a calendar month for a home-health patient) and 99378 (for 30 minutes or more in a calendar month for a hospice patient).

Keep in mind that other insurers' policies for covering CPO may differ from Medicare's, so you may be able to use all these new codes after all. And for the CPO services that Medicare does cover, you can still be paid for them if you use the codes correctly.

Copyright © 1998 by the American Academy of Family Physicians.
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