Code Description Who can Payers PDCM Notes Documentation provide BCBSM service? 99358, 99358: Physicians; Medicare N Medicare Description: CCM and complex CCM reimburse providers 99359: [except Prolonged E/M CCM and complex CCM for clinical staff time spent providing care management Prolonged CPC+ service before services, not time spent by physicians. For those cases in Practitioners; reimburse providers for clinical E/M Service patients] and/or after Physician staff time spent providing care which a physician spends a significant amount of time outside the usual office visit addressing an individual direct patient Assistants management services, not time care, first 60 spent by physicians. For those patient’s needs minutes cases in which a physician spends a significant amount of Documentation: time outside the usual office Duration of visit visit addressing an individual Content of the medically necessary evaluation and patient’s needs, CMS will make management service and prolonged services that you payment under these two codes bill beginning in 2017. Direct face-to-face time with the patient Start and end times of the visit In discussing services, CMS Date of service. 99359: warns the time counted toward Prolonged E/M these codes must be separate service before and distinct from time spent and/or after providing any other service direct patient reimbursable under the MPFS care, each including, but not limited to, additional 30 new and established patient minutes (listed office visits, transitional or separately chronic care management with 99358) services or care plan development. For details and complete listing of Prolonged E/M service elements: The CPT prefatory language and reporting apply for the Medicare billing of these codes, for example, CPT codes 99358 and 99359:
Code Description Who can provide service? Payers PDCM BCBSM Notes Documentation 99358, 99359: Prolonged E/M Service 99358: Prolonged E/M service before and/or after direct patient care, first 60 minutes Physicians; Practitioners; Physician Assistants Medicare [except CPC+ patients] N Medicare CCM and complex CCM reimburse providers for clinical staff time spent providing care management services, not time spent by physicians. For those cases in which a physician spends a significant amount of time outside the usual office visit addressing an individual patient’s needs, CMS will make payment under these two codes beginning in 2017. In discussing services, CMS warns the time counted toward these codes must be separate and distinct from time spent providing any other service reimbursable under the MPFS including, but not limited to, new and established patient office visits, transitional or chronic care management services or care plan development. The CPT prefatory language and reporting apply for the Medicare billing of these codes, for example, CPT codes 99358 and 99359: Description: CCM and complex CCM reimburse providers for clinical staff time spent providing care management services, not time spent by physicians. For those cases in which a physician spends a significant amount of time outside the usual office visit addressing an individual patient’s needs Documentation: Duration of visit Content of the medically necessary evaluation and management service and prolonged services that you bill Direct face-to-face time with the patient Start and end times of the visit Date of service. For details and complete listing of Prolonged E/M service elements: 99359: Prolonged E/M service before and/or after direct patient care, each additional 30 minutes (listed separately with 99358)
multipayer-g-and-cpt-billing-summary-and-documentation-july-25-2018.docx