Code Description Who can Payers PDCM Documentation provide service? 99487, 99489: 99487: BCBSM Y Description: For time spent interacting with other Health Complex MA Commercial, providers and/or community agencies in the medical Description: For time Chronic Care Lead Care BCBSM neighborhood to coordinate services needed to manage spent interacting with Coordination Health Manager and Medicare the patient (time spent communicating with the patient, other providers Services First hour of Other Care Advantage, the patient’s PCP or the patient’s primary care giver is not and/or community Priority included) clinical staff Team agencies in the time directed Members Health (all medical plans except by a Documentation: neighborhood to physician or Priority Health Medicaid), Date of Contact coordinate services Medicare other QHP Duration of Contact needed to manage qualified [except Name and Credentials of the allied professional on the patient (time CPC+ health care Medicare the Care Team making the contact spent communicating Physicians; professional patients] Identification of the Provider or community agency with the patient, the Certified Nurse with no face- with whom the discussion is taking place patient’s PCP or the Midwives; face visit, Nature of the discussion and pertinent to the patient's patient’s primary care Clinical Nurse per calendar individualized care plan and goal achievement. giver is not included) Specialists; month. Conditions of Payment: Nurse Priority Health- Include documentation fields listed 99489: May be by phone or Practitioners; Medicare in "all payer" section, plus the following: person-to-person or 60 minutes of Accumulated Physician care Diagnoses discussed Health time must be 31 Assistants management Care Team coordination activities Each minutes to bill working in a services each Names of providers contacted in the course of additional 30 99487 practice that coordinating care. minutes of Claims Reporting meets all CCM Development and/or maintenance of the Care Plan clinical staff Requirements: program time directed Reported once requirements- by a physician per calendar *”Incident to” or other month to applies. qualified encompass health care accumulated professional, time. Bill at the per calendar end of the month month. (An
Code Description Who can provide service? Payers PDCM Documentation 99487, 99489: Complex Chronic Care Coordination Services 99487: Health First hour of clinical staff time directed by a physician or other qualified health care professional with no face visit, per calendar month. Medicare 60 minutes of care management services each MA Lead Care Manager and Other Care Team Members Priority Health QHP Medicare Physicians; Certified Nurse Midwives; Clinical Nurse Specialists; Nurse Practitioners; or Physician Assistants working in a practice that meets all CCM program requirements- *”Incident to” applies. BCBSM Commercial, BCBSM Medicare Advantage, Priority Health (all plans except Medicaid), Medicare [except CPC+ patients] Y Health Description: For time spent interacting with other providers and/or community agencies in the medical neighborhood to coordinate services needed to manage the patient (time spent communicating with the patient, the patient’s PCP or the patient’s primary care giver is not included) Conditions of Payment: May be by phone or person-to-person Accumulated time must be 31 minutes to bill 99487 Claims Reporting Requirements: Reported once per calendar month to encompass accumulated time. Bill at the end of the month Description: For time spent interacting with other providers and/or community agencies in the medical neighborhood to coordinate services needed to manage the patient (time spent communicating with the patient, the patient’s PCP or the patient’s primary care giver is not included) Documentation: Date of Contact Duration of Contact Name and Credentials of the allied professional on the Care Team making the contact Identification of the Provider or community agency with whom the discussion is taking place Nature of the discussion and pertinent to the patient's individualized care plan and goal achievement. Priority Health- Include documentation fields listed in "all payer" section, plus the following: Diagnoses discussed Care Team coordination activities Names of providers contacted in the course of coordinating care. Development and/or maintenance of the Care Plan 99489: Health Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. (An face-