Primary care providers have a number of options available to seek Medicare reimbursement for monitoring services or other activities that occur outside of a face-to-face encounter. These options include the following:
1. Chronic Care Management (CCM) - Providers may bill CPT code 99490 if they spend at least 20 minutes a month monitoring a patient with at least two chronic conditions.
2. Transitional Care Management (TCM) - Providers may bill CPT code 99495 (moderate complexity) or CPT code 99496 (high complexity) if they manage the transition of a patient from an inpatient, observation or nursing facility to the patient's home or community setting. Importantly, a face-to-face visit is required to bill either of these TCM codes.
3. Home Health Supervision - Providers may bill CPT code G0181 for 30 minutes of supervision of home health services, including the review and monitoring of the patient's plan of care and the coordination of the patient's care.
Medicare maintains edits in place to preclude the billing of a combination of the above-mentioned codes. In other words, it is necessary for providers to select the most accurate CPT code. As such, Precision recommends consideration of the following factors:
- Did a face-to-face visit occur? The TCM codes require a face-to-face visit while the CCM codes and home health code do not.
- TCM code 99495 reimburses $165.30; CCM code 99490 reimburses $42; and Home Health code G0181 reimburses approximately $110.
- Providers may bill a TCM code as the patient transitions from an inpatient setting to a home setting and in the subsequent month bill the home health code as they monitor the patient's plan of care.
Keep in mind the documentation requirements for the billing of any of the monitoring codes and ensure those requirements are fulfilled.
Precision would be glad to review the monitoring service CPT codes available with you to ensure you are capturing them as you provide transitional and continued monitoring care to your patients. Please don't hesitate to contact us if we can be of assistance.