Several noteworthy new payment opportunities and code revisions took effect on Jan. 1, including these:
• Cognitive assessment and care plan services CPT code 99483, “Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home,” replaces HCPCS code G0505. Code 99483 can be billed once every 180 days per physician or qualified health professional (QHP). Medicare’s national payment allowance for this service is $241.85.
• General behavioral health integration care management code 99484, “Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other QHP, per calendar month… ,” can be billed for the initial assessment and care plan formulation by the physician or other QHP, and also applies to subsequent months when staff spend at least 20 minutes following the care plan.
• Two new HCPCS codes for prolonged preventive services have been added: G0513, “Prolonged preventive service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (List separately in addition to code for preventive service)),” and G0514, “ … each additional 30 minutes.”
• Anticoagulation management codes 99363 and 99364 have been deleted and replaced with home and outpatient international normalized ratio (INR) monitoring services codes 93792 (for initial set-up and education) and 93793 (for review and subsequent management of a daily test).
Check your CPT and HCPCS manuals for detailed requirements about these codes and other changes.
Adapted from “CPT Code Changes for Family Medicine in 2018.”
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