CODING & DOCUMENTATION

 

Fam Pract Manag. 2021 Mar-Apr;28(2):37.

Author disclosure: no relevant financial affiliations disclosed.

ALTERNATIVE CODES FOR CHRONIC CARE MANAGEMENT

Q

Most private insurance companies in our area do not pay for chronic care management (CCM) services (e.g., 99490, 99487, and 99489). Are there other codes for capturing this work?

A

Yes, but typically these codes are not allowed for services provided by clinical staff. Some health plans that do not pay for CCM because they consider it bundled with face-to-face services will pay for other non-face-to-face physician services. These examples are from past reimbursement policies of commercial health plans:

Care plan oversight. While many health plans follow Medicare and don't pay for less than 30 minutes of care plan oversight in a calendar month when performed by a physician or other qualified health professional (QHP), some pay when the time exceeds 30 minutes. This may include only the following services:

  • 99340, 99375, 99378, and 99380 (care plan oversight codes for ≥ 30 minutes of physician time),

  • G0179 and G0180 (physician certification or recertification of a home health patient for Medicare-covered home health services under a home health plan of care),

  • G0181 (physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency),

  • G0182 (physician supervision of a patient under a Medicare-approved hospice).

Virtual and remote services. Health plans are increasingly paying for these services:

  • 99421-99423 (online digital E/M for an established patient, for up to seven days, cumulative time),

  • 99452 (interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes),

  • G2010 (remote evaluation of recorded video and/or images submitted by an established patient),

  • G2012 and G2252 (brief communication technology-based service, e.g., virtual check-in, by a physician

ABOUT THE AUTHOR

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Author disclosure: no relevant financial affiliations disclosed.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

 
 

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