Code Who Payers PDCM Documentation can BCBSM provide G9001: BCBSM Y All Payers Description: Comprehensive Assessment and Care Plan Initiation of Care Development with Patients, Prior to Enrollment in Care RN, Comprehensive Description: Management Management (and annually thereafter). LMSW, assessment and care plan (Comprehensive CNP or PA Medicare development with patients, prior Assessment) Documentation: who meet Advantage, to enrollment in care Priority the management (and annually Lead Care Manager Name, Licensure. BCBSM Only payable when Health conditions thereafter) service is delivered by a RN, LMSW, CNP or PA who meet the of a lead G9001 is not required to be conditions of Lead Care Manager. Priority Health: RN, RD, MSW, care billed for the other PDCM codes CDE, CAE, Pharmacist, PA, NP manager to be payable (though it is an Identify Primary Care Physician and Contact Information expectation that a G9001 be Date of service = date assessment is completed. Duration, and BCBSM MA completed). Modality of Contact (face-to-face required, or can be combination Same as Conditions of payment: of the face-to-face and phone). Visit, Face-to-Face Visit above, Contacts must add up to at Visit Duration: 30 min but RNs 30 minutes of BCBSM- Contacts must total at least 30 minutes in duration and discussion with the with at least one face to face encounter with patient. LMSWs member or member’s Priority Health- Work must encompass minimum of 30 must be representative/caregiver. minutes, some of may be without the patient present. direct Must include a face-to-face Specific Assessments such as depression, functionality, urologic, physician visit. Patient/caregiver etc. supervision must formally agree with Medical Treatment Regimen care plan and this must be Risk Factors Priority documented in the medical Physical Status Health record. Emotional Status (PH)(BCBSM) QHP Claims Reporting Unmet Needs/Available Resources Perceived Barriers to Treatment Plan Date of Requirement: Adherence service should be the date Anticipated interventions to help patient achieve goals the assessment is Self-Management Activities completed for patients entering into care management. If patient
Code Who can provide Payers PDCM BCBSM Documentation G9001: Initiation of Care Management (Comprehensive Assessment) BCBSM RN, LMSW, CNP or PA who meet the conditions of a lead care manager BCBSM MA Same as above, but RNs and LMSWs must be direct physician supervision Priority Health QHP Medicare Advantage, Priority Health Y All Payers Description: Comprehensive assessment and care plan development with patients, prior to enrollment in care management (and annually thereafter) G9001 is not required to be billed for the other PDCM codes to be payable (though it is an expectation that a G9001 be completed). Conditions of payment: Contacts must add up to at 30 minutes of discussion with the member or member’s representative/caregiver. Must include a face-to-face visit. Patient/caregiver must formally agree with care plan and this must be documented in the medical record. Claims Reporting Requirement: Date of service should be the date the assessment is completed for patients entering into care management. If patient Description: Comprehensive Assessment and Care Plan Development with Patients, Prior to Enrollment in Care Management (and annually thereafter). Documentation: Lead Care Manager Name, Licensure. BCBSM Only payable when service is delivered by a RN, LMSW, CNP or PA who meet the conditions of Lead Care Manager. Priority Health: RN, RD, MSW, CDE, CAE, Pharmacist, PA, NP Identify Primary Care Physician and Contact Information Date of service = date assessment is completed. Duration, and Modality of Contact (face-to-face required, or can be combination of the face-to-face and phone). Visit, Face-to-Face Visit Visit Duration: 30 min BCBSM- Contacts must total at least 30 minutes in duration with at least one face to face encounter with patient. Priority Health- Work must encompass minimum of 30 minutes, some of may be without the patient present. Specific Assessments such as depression, functionality, urologic, etc. Medical Treatment Regimen Risk Factors Physical Status Emotional Status (PH)(BCBSM) Unmet Needs/Available Resources Perceived Barriers to Treatment Plan Adherence Anticipated interventions to help patient achieve goals Self-Management Activities
multipayer-g-and-cpt-billing-summary-and-documentation-july-25-2018.docx