Medical Billing ServicesMedical CodingPrimary Health CareRevenue Cycle Management (RCM)

Primary Care Codes for Payment in 2020

The technique by which Current Procedural Terminology (CPT) codes are developed with the goal that physicians can get paid for the services and procedures they give is an extremely entangled procedure, one that deserves some explaining. Furthermore, Medical Billers and Coders (MBC) is effectively occupied with this procedure and advocates for the eventual benefits of its clients, which incorporates improved payment for primary care and subspecialists under Medicare.

CPT codes are utilized to report medical services and procedures performed by physicians and other health care experts. The CPT Editorial Panel meets during the time to audit new and existing CPT codes for approval or updating. Values are assigned to new CPT codes and re-examined for existing codes by the Relative Value Update Committee (RUC), an advisory body that makes recommendations about the value of physician services to the Centers for Medicare and Medicaid Services (CMS).

Payments to physicians are then made on a for each visit or per-procedure basis as characterized by the CPT codes. Most private payers adopt the values for services from CMS yet may apply diverse transformation factors.

Below is the list of codes (ref: ACP’s Coding ) that physicians can use:

  • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, the cumulative time during the 7 days; 5–10 minutes
  • 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
  • 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, the cumulative time during the 7 days; 21 or more minutes

Digitally Stored Data Services/Remote Physiologic Monitoring

The two new codes—99473 and 99474—support home blood-pressure monitoring, which provides useful information physicians can use to better diagnose and manage hypertension. Home BP monitoring also helps patients to take an active role in the process.

  • 99473: Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration;
  • 99474: separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with the report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient.

Remote Physiologic Monitoring Treatment Management Services

  • 99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes;
  • 99458: each additional 20 minutes (List separately in addition to code for primary procedure).

Chronic Care Management and Complex Chronic Care Management

  • G2064: Comprehensive care management services for a single high-risk disease, e.g., Principal Care Management, at least 30 minutes of physician or other qualified health care professional  time per calendar month with the following elements: One complex chronic condition lasting  at least 3 months;
  • G2065: Comprehensive care management for a single high-risk disease service, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months;
  • 99490: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month;
  • G2058: Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month;
  • 99487: Complex chronic care management services, with the following, required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline, establishment or substantial revision of a comprehensive care plan, moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month;
  • 99489: Complex chronic care management services, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

Advance Care Planning

  • 99497: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate;
  • 99498: Advance care planning; each additional 30 minutes.

Behavioral Health Management

  • 99484: Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional time, per calendar month.

Psychiatric Collaborative Care Model

  • 99492: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional;
  • 99493: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional;
  • 99494: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.

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To help physicians and groups of physicians’ better reimbursement, the Medical Billers and Coders  (MBC) offers medical billing service with a dedicated billing expert team. Contact us today to schedule a call with our billing expert.

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