PRINCIPLE CARE MANAGEMENT (PCM)

99424 (Replaces G2064) 
Principal care management services for a single high-risk disease, at least 30 minutes of physician or other qualified health care professional time per calendar month

99425 (Extension of 99424)
Principal care management services, each additional 30 minutes of physician or other qualified health care professional time per calendar month.

99426 (Replaces G2065)
Principal care management services for a single high-risk disease, at least 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.

99427 (Extension of 99426)
Principal care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.

BEHAVIORAL HEALTH INTEGRATION (BHI) / COORDINATED CARE MANAGEMENT (CoCM)

99484 – $43
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, with the following required elements:

• Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
• Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes
• Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation
• Continuity of care with a designated member of the care team

99492 – $151
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

• Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional
• Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan
• Review by the psychiatric consultant with modifications of the plan if recommended
• Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant
• Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies

99493 – $148
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

• Tracking patient follow-up and progress using the registry, with appropriate documentation.
• Participation in weekly caseload consultation with the psychiatric consultant
• Ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers
• Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant
• Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
• Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment

99494 – $58
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 (List separately in addition to code for primary procedure)

• Listed separately and used in conjunction with 99492 and 99493

G0512 – $147
Rural health clinic or federally qualified health center (RHC or FQHC) only, psychiatric collaborative care model (psychiatric COCM), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month as maintained by CMS falls under Other Services .

TRANSITIONAL CARE MANAGEMENT (TCM) CPT BILLING CODE

99495 – $205
Transitional care management services with moderate medical decision complexity. (face-to face visit within 14 days of discharge)

99496 – $278
Transitional care management services with high medical decision complexity. (face-to-face visit within 7 days of discharge)

G2010 – $12
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

REMOTE PHYSIOLOGIC MONITORING (RPM)

99457 – $49

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes

99458 – $40

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes

99453 – $19

Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc) initial; setup and patient education on use of equipment

99454 – $50

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

99091 – $56

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time

COMMUNICATION TECHNOLOGY-BASED SERVICES (VIRTUAL CHECK-IN) CPT BILLING CODE

G2012 – $14
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management (E/M) services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.