CODING & DOCUMENTATION
Fam Pract Manag. 2021 Mar-Apr;28(2):37.
Author disclosure: no relevant financial affiliations disclosed.
- ALTERNATIVE CODES FOR CHRONIC CARE MANAGEMENT
- ONLINE DIGITAL E/M BY NON-PHYSICIANS
- REMOTE MONITORING WITH CCM
- RETINAL IMAGING
ALTERNATIVE CODES FOR CHRONIC CARE MANAGEMENT
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?
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
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Send questions and comments to firstname.lastname@example.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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