This resource covers Psychiatric Collaborative Care Management Services 99492, 99493, 99494 and
Care Management for Behavioral Health 99484.
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.
Coding Guide – Advanced Primary Care Management
Care management services have played an increasing role patient care management. CMS and other payers no longer pay only for face-to-face services, a concept that would have been unthinkable 15 years ago. CMS began paying for Transitional Care Management Services in 2013, for chronic care management services in 2014. In the 2016 Final Rule, CMS […]
Advance Care Planning Q&A
Does your practice provide Advance Care Planning (ACP) services? If so, read on and watch the video below. Q:Â Can it be billed as a group service? A:Â No. It is a service to an individual beneficiary and/or their family member(s) or surrogate. Q:Â Does it follow the mid-point rule? Should I start to bill 99497 at 16 […]
Care Management Services | Webinar
Recorded October 30th, 2025
1 CEU expires 10/30/26
Guest presenter Pam Warren of MaineHealth
Care management services include Transitional Care Management, Chronic Care Management, Principal Care Management and Advanced Primary Care Management. Each type of care management has its own purpose and service requirements.
Fueling Compliance: Cracking the Code on DSMT & MNT | Webinar
Recorded June 26th, 2025
1 CEU expires 6/30/26
Guest presenter Darren Goodwin of MaineHealth
Join us for an overview of Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT) services., outlining key coverage criteria, provider qualifications, and documentation requirements.
Coding for Medical Nutrition Therapy Services
Medical Nutrition Therapy Services (MNT) have been a covered benefit under Medicare since the early 2000’s. This article will describe the rules related to coding for medical nutrition therapy services for Medicare patients. This article also addresses common questions about coverage under the Medicare benefit with brief answers and links to the source documents for […]
CMS Adopts Codes for Caregiver Training Services (CTS)
This is information from the 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023. You can read it for yourself by downloading the pdf below. 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023 MLN Matters article Jan. 2024 – PDF These are not on the telehealth list; they are in person services […]
Anticoagulation Management
There are a few remarkable things about coding for anticoagulation management services. First, payment for these services bolsters Medicare’s support for primary care. This monitoring is typically done by either primary care or cardiology and was considered part of the pre-and post-work for an office visit. Although there were CPT® codes for anticoagulation management prior […]
Community Health Integration (CHI) Services
Updates from 2026 Final Rule in this article. Marriage and Family Therapists and Mental Health Counselors may personally perform CHI services. They may not supervise auxiliary staff in doing the work, because they don’t have incident to in their statutory benefit, so may not bill for work performed by someone else 90791 is added as […]
Care Plan Oversight | Coding reference sheet
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. RVUs are assigned by Medicare for these CPT® codes. Some have a bundled indicator and some invalid, which means […]
Consent for Communication Technology-Based Services (CTBS)
Both CPT and CMS have developed codes for non-face-to-face communication-based technology services in recent years. In addition to care management services, these include interprofessional consults, remote physiologic and therapeutic monitoring, and on-line digital E/M services In the 2020 Physician Fee Schedule Final Rule, CMS clarified the type of patient consent that is required to perform […]
CMS Finalizing Principal Illness Navigation (PIN) Services
This is information from the 2024 Physician Fee Schedule Final Rule https://public-inspection.federalregister.gov/2023-24184.pdf CMS developed four HCPCS codes for Principal Illness Navigation. This service is intended to help patients with serious conditions navigate their health care treatment. PIN services are incident-to services so may only be performed in a non-facility setting Informed consent is required-the patient must […]
Chronic Care Management | Reference Sheet
This quick reference sheet includes clinical staff time, care planning and billing practitioner work criteria for chronic care management services. When coding for care management services services, practitioners need to distinguish between chronic care management and complex chronic care management, between who does the work, the practitioner or clinical staff, and the amount of time […]
Principal Care Management (PCM) Services – CPT® codes 99424—99427
There are two sets of  CPT® codes for Principal Care Management 99424 and 99425 are for time spent by a physician or other qualified health care professional (someone with E/M in their scope of practice) and 99426 and 99427 for clinical staff time directed by a physician or other qualified health care professional These are […]
Chronic Care Management
Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least a year. See also Principal Care Management And, download our Care Management Coding Guide and CCM Quick Reference Sheet Use of CPT® codes 99490, 99439, 99487, 99489, 99491 and HCPCS […]
Transitional Care Management
This article provides answers to frequently asked questions related to transitional care management services. It includes details about billing for TCM services including: When are CPT® 99495 & 99496 used? What are the requirements for TCM? Can We Code TCM and 99214 Together? Transitional care management for discharge Everyday Coding Q&A – Who needs to […]
Outpatient Diabetes Self-Management Training (DSMT) Services
Medicare covers diabetes self-management training (DSMT) services are a covered benefit under Medicare when all requirements are met. This article will provide an overview of the requirements and provide answers to some commonly asked questions. It will also provide you with links to the source material for DSMT coverage in the CMS Medicare Benefit Policy […]
Checklist for CPT® code 99483 | cognitive assessment code for dementia
Is your practice performing cognitive assessments for patients with dementia, using CPT® code 99483? If so, use this checklist to make sure you have documented all of the required components.
Advance Care Planning | CPT® 99497, 99498
Advance Care Planning CPT® Codes Overview Medical practices perform countless tasks every day for which there is no payment. CMS continually states that it wants to support non-procedural and in the past decade has added payment for some non-face-to-face services, including Care Plan Oversight, Transitional Care Management and Chronic Care Management. CPT® Codes 99497 & […]
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. Be sure to download the Care Plan Oversight quick reference sheet below.