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New Coding Opportunity

Chronic Care Management (CCM) services offer the opportunity to receive payment for the non-face-to-face services provided to patients by clinical staff. There are certain requirements for billing CCM, one of which is the establishment of a care plan that provides the foundation of the care provided by staff, often over the telephone.

Many physicians rejected this opportunity altogether, given the time and energy involved in creating the initial care plan. The Centers for Medicare & Medicaid Services (CMS) acknowledged this sentiment with the creation of a new CPT® code for the development and initiation of the patient’s care plan, to be used by physicians and advanced practice providers. CMS’ rationale? Allow the use of a code for “… the CCM initiating visit to account for the work of the billing practitioner in assessing the beneficiary and establishing the CCM care plan.”

For use with Medicare patients, G0506 is the “comprehensive assessment of and care planning for patients requiring chronic care management services, including assessment during the provision of a face-to-face service.” G0506 is an add-on code, that is listed separately from the primary service. For example, a G0506 can be billed in addition to a 99204. As of January 1, 2017, this CPT® code can be used; however, the code can only be billed once, per patient.

About The Author

Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.

The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.

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