Coding Guide – Care Management Services

CMS has a stated goal of recognizing management services provided outside of an office visit. In particular, valuing and paying for care management and other non-face-to-face services. Sometimes, this means recognizing existing CPT^® codes, and changing the status indicator from bundled to active, so that it is a covered service. Sometimes, it means working with CPT^®’s chronic care management committee to develop new codes that describe management services.

Although CMS is thinking about primary care, many of these codes can be billed by any specialty physician. Transitional care management may be billed by one physician/NP/PA who is providing the TCM services. (The surgeon may not bill during the global period.) Chronic care management may be billed by any specialty physician who is providing the service. The new collaboration of care for patients with behavioral health diagnoses is meant for primary care practices. (PCCM).

This guide also discusses the rules for home health certification. The payment isn’t high, but it is a service that is commonly performed.

Other non-face-to-face services, including on-line digital evaluation and HCPCS codes G2012, G2010 and G2252 are discussed in articles on CodingIntel.

Table of Contents

• Home health certification – G0180, G0179
• Transitional care management – 99495, 99496
• Chronic care management – 99487, 99489, 99490
• CCM by physician/NPP – 99491
• CPT bundling
• Date of service and clinical staff
• Principal Care Managment Services (PCM) – 99424—99427
• Psychiatric Collaborative Care Management Services (PCCM) – 99492—99494
• General Behavioral Health Integration Care Management – 99484

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Last revised March 10, 2023 - Betsy Nicoletti
Tags: care management, primary care_essential resource

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