Don’t forget Care Plan Oversight

• There are two sets of codes for care plan oversight, CPT and HCPCS codes
• 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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