Care Plan Oversight, non-Medicare

March 3rd, 2009 - Codapedia Editor
Categories:   Coding  
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Although Medicare developed its own set of HCPCS codes for Care Plan Oversight, there are CPT® codes which describe this service.  The amount of time, and the definition of the service are both different from the CMS HCPCS codes.  See the article in Codapedia for the Medicae CPO codes.

The CPT® codes are in the code range of 99374--99380.  For these codes:

  • They are reported for each a calendar month
  • Only one physician may report in a month
  • The work involved in "low intensity or infrequent supervision" is paid for in the pre and post work of an E/M service and is not reported with these codes

There are three sets of codes for physician supervision of a patient in the care of a home health agency, hospice or nursing facility.  Each is divided into 15-29 minutes or 30 minutes or more in a calendar month.  (Compare this with the CMS HCPCS codes: the minimum time is 30 minutes in a calendar month, and CPO for home health agency patients and hospice patients is covered, but not nursing facility patients.) The Medicare codes are G0180 and G0181.

According to the CPT® book code description, patient must require complex and multi-disciplinary treatment modalities, which requires the physician to develop and review plans and review reports and diagnostic studies.  Again, unlike the HCPCS codes developed by Medicare, these codes allow the physician to include time spent on the phone with the patient's family members, caretakers or key decision makers to be counted into the CPO time.

Document in the medical record the date of the CPO time, what was done, and the duration of the time for that date.  At the end of the month, bill for those services that met the time threshold.

Check with your commercial payers to see if they pay for the service.  These codes are not valid for Medicare. 

The services that may be included in the time are:

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