CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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Don’t forget Care Plan Oversight

  • There are two sets of codes for care plan oversight, CPT (99374–99380) and HCPCS codes (G0181, G0182)
  • The requirements for each are different, including time thresholds and what activities may be included in the CPO time.

When CPT® developed and CMS recognized chronic care management (CCM) codes, many primary care groups looked at the requirements and took a pass.  Even after CMS relaxed the requirements, it seemed too complicated and difficult for the reimbursement level.

You can read about CCM on CodingIntel or download the Care Management coding guide, if you want to reconsider providing and billing for CCM.  And, CMS has a billing guide, of course.

But, this article is going to look at Care Plan Oversight (CPO) codes not CCM.

CPT® and CMS codes for Care Plan Oversight

There are two sets of Care Plan Oversight codes, CPT® and HCPCS codes.

Medicare recognizes and pays for the HCPCS codes.

Commercial payers are more likely to recognize and pay CPT® codes, although there is no guarantee that they will consider it a covered service. That is the first complexity of CPO.

Not only are there two sets of codes, but the time requirements for the two sets are different.
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Relevant Search Terms: G0181, G0182, 99374, CPT and HCPCS codes for CPO, care plan oversight, Care Plan Oversight billing

Last revised November 16, 2020 - Betsy Nicoletti
Tags: Care plan oversight (CPO), CCM, prolonged services

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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