Code Description Who can Payers PDCM Notes Documentation provide BCBSM service? 98967, 98966: 5-10 BCBSM Y All payers Description: Non-face-to-face care management minutes of MA Description: Non-face-to-face care services provided to a patient or patient’s Telephone medical Lead Care BCBSM representative/caregiver using the telephone or by management services provided to a Services: discussion Manager and Medicare other real-time interactive electronic communication patient or patient’s Telephone Other Care Advantage, representative/caregiver using the assessment Priority Team telephone or by other real-time Documentation: and Members Health (all interactive electronic communication Lead Care Manager Name, Licensure (payable management PH plans) Conditions of Payment: when delivered by any of the qualified allied services Priority Not for reminder about provided by a personnel approved for PDCM) Health QHP qualified non- appointments or conveying test Date, Time, and Duration of Call 98967: 11-20 physician results. Phone Visit minutes of health care For substantive discussions All active diagnoses relevant to the medical professional focused on the patient’s care plan encounter discussion and goal achievement. Medications Claims Reporting Requirements: Short-Term Goal, target date Code selection depends on Long-Term Goal, target date time spent in discussion with the Care and Progress to Goal(s) patient Nature of the Discussion and Pertinent Details Report all active dx Updated Status on Patient’s Medical BCBSM/BCBSM MA 21-30 Condition Documented consent from patient minutes of Care Needs and Progress to Goal agreeing to phone contacts medical Any revisions to the Care Plan initiated by the care manager discussion Interventions, and Target Dates You may not quantity bill these Patient/Care Giver’s Level of codes Understanding Only one of these codes may be Readiness for Change billed per day. Name of Individual(s) in Priority Health attendance, relationship with patient Codes cannot be quantity billed
Code Description Who can provide service? Payers PDCM BCBSM Notes Documentation 98967, Telephone Services: Telephone assessment and management services provided by a qualified non- physician health care professional 98966: 5-10 minutes of medical discussion MA Lead Care Manager and Other Care Team Members Priority Health QHP BCBSM BCBSM Medicare Advantage, Priority Health (all PH plans) Y All payers Description: Non-face-to-face care management services provided to a patient or patient’s representative/caregiver using the telephone or by other real-time interactive electronic communication Conditions of Payment: Not for reminder about appointments or conveying test results. For substantive discussions focused on the patient’s care plan and goal achievement. Claims Reporting Requirements: Code selection depends on time spent in discussion with the patient Report all active dx BCBSM/BCBSM MA Documented consent from patient agreeing to phone contacts initiated by the care manager You may not quantity bill these codes Only one of these codes may be billed per day. Priority Health Codes cannot be quantity billed Description: Non-face-to-face care management services provided to a patient or patient’s representative/caregiver using the telephone or by other real-time interactive electronic communication Documentation: Lead Care Manager Name, Licensure (payable when delivered by any of the qualified allied personnel approved for PDCM) Date, Time, and Duration of Call Phone Visit All active diagnoses relevant to the encounter Medications Short-Term Goal, target date Long-Term Goal, target date Care and Progress to Goal(s) Nature of the Discussion and Pertinent Details Updated Status on Patient’s Medical Condition Care Needs and Progress to Goal Any revisions to the Care Plan Interventions, and Target Dates Patient/Care Giver’s Level of Understanding Readiness for Change Name of Individual(s) in attendance, relationship with patient 98967: 11-20 minutes of medical discussion 21-30 minutes of medical discussion
multipayer-g-and-cpt-billing-summary-and-documentation-july-25-2018.docx