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  • Billing Codes
    • G9001: Comprehensive Assessment
    • G9002: Maintenance
    • 98966-98968: Telephonic
    • 99487, 99489: Care Coordination (without patient)
    • G9007: Team Conference
    • 98961, 98962: Group Education
    • G9008: Care Oversight
    • S0257: Counseling Regarding Advance Directives
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FAQs

It is expected that all team members act within their scope of licensure, certification, or authorization by the physician, physician assistant or advanced practice nurse.

Payer-specific information is indicated in the answers below.

General FAQs

Q: Where can I locate the BCBSM PDCM codes, descriptions, and billing guidelines?

A: Blue Cross Blue Shield of Michigan or our current billing guide.

Q: Is training required for care team members to bill PDCM CPT Codes?

A: Yes, must be completed within 6 months of submitting codes. Information regarding required courses can be found here.

Q: Can unlicensed care-team members bill PDCM codes?

A: Yes, unlicensed care-team members such as medical assistants or community health workers can bill for telephonic services (98966-98968) and care coordination codes (99487-99489).

Q: Can all 12 PDCM codes be conducted telephonically?

A: Due to the pandemic, BCBSM allows all 12 PDCM codes to be conducted via telephone or virtual (via secure video conferencing). Although, not always possible, in-person or secured video conferencing is the preferred. If a patient is unable or does not want to return to office; this information should be clearly documented within the medical record.

Q: Can care management services be rendered via secure video conferencing with a submission of the 12 PDCM codes?

A: Yes, services identified as virtual may require a modifier for the Commercial PPO members only.

Q: If I interact with a patient's caregiver, can I bill care management codes if the patient is not present?

A: Yes, if the name of the caregiver, relationship to patient and appropriate consent is provided and documented within the medical recorded.

G9001 (Comprehensive Assessment) and G9002 (Maintenance)

Q: Can a care team member bill a G9002 without a preceding G9001?

A:  Yes, care team members are not required to bill a G9001 prior to billing G9002.  

Q: Does submitting a G9001 or G9002 require a time limit?  

A: No; however, if you’re submitting a G9002 and a coordinated care visit is >45 minutes, you may quantity bill. A G9001 cannot be quantity-billed.

Q: Can the G9001 and G9002 be billed on the same day?

A: Yes.

Q: Can the initial assessment (G9001) be billed if the patient decided not to proceed with care management services?

A: Yes.

98966-98968: Telephonic Codes

Q: Are CPT codes 98966, 98967 and 98968 appropriate for contacting  members for  emergency department visits or hospitalizations when not part of transition of care services?

A: Yes, these codes can be submitted based upon duration of time spent on the telephonic      outreach with patient/caregiver.

Q: Can the PDCM codes be billed simultaneously?

A: Yes, each of the codes maybe billed alongside the other codes. As an example, G9002 can be  billed on the same day as a telephonic service (98966, 98967 and 96968).

As a reminder, care coordination services (99487/99489) is time accumulated over a course of a  month, not time spent within a specific day.   The best practice is to bill at the end of the month, adding up all the minutes.

Q: Can a group visit (98961 or 98962) and a phone visit (98966, 98967, 98968) be billed on the same day?

A: These codes should only be billed on the same day if contact is completed as a distinct service. (e.g., Patient attends group education in the morning and the care team member contacts patient as a follow up in the afternoon).

99487, 99489: Care Coordination (without patient)

Q:  Historically, many forms were completed as phone outreach however many organizations have converted to online. Would time spent completing online forms such as CPS intake, court and/or school documents be considered as care coordination?

A: Yes, as the care-team member would be spending the same amount of time on the telephone as he/she would be online.

Q: How can I get reimbursed for time spent coordinating services with other providers/services (i.e., home health, specialty offices, community resources, etc.)?

A:  When providing non-face-to-face clinical coordination with the patient-centered medical neighborhood, a care team member must accumulate at least 31 minutes of time spent within a calendar month and submit code: 99487 or 99489. Individual organizations will need to develop internal workflows for capturing and tracking each contact until the total time is collected.

G9007: Team Conference

Q: What constitutes a care team conference? What code(s) can I use to bill for a care-team conference?

A: A care-team conference constitutes a face-to-face or telephonic conversation between the primary provider (physician or APP if acting as primary provider) and one or more care-team members regarding a patient status. A team conference does not include the patient. The code used to bill for a care team conference is G9007.

Q: Can the G9007 be billed if two team members are discussing a potential patient for care management prior to the patient coming onto service, or can this only occur with the physician?

A: No, this is a physician/provider code. It can only be billed when discussing with the physician/APP.

98961, 98962: Group Education

Q: Can an educational visit be conducted via telephone?

A:  Yes, with appropriate documentation within medical record clearly stating that patient can’t or will not present for face-to-face visit.

Q: Can a physician bill a 98961 or 98962?

A: No.

Q: If a family member attends a training, can a care-team member submit claim on behalf of the patient?

A: No.

G9008: Care Oversight

Q: Does a physician need to bill a G9008 prior to a care-team member submitting subsequent PDCM codes?

A: No.

Q: When a physician coordinates care or interacts with another health care provider (specialist, paramedic, and/or care manager) seeking guidance or additional background information on a patient, is this billable? 

A: Yes, a physician-delivered service may be billed when coordinating care or engaging patients in care management services.  A physician would utilize code G9008 for services rendered. Note: This is not applicable for APPs.

Q: Can a G9008 be billed for unsuccessful attempts to engage patients in care management?

A: Yes.

Q: Can a G9008 be billed with a Medicare Wellness Exam?

A: Yes.

Q: If the care manager speaks with the physician and the physician decides to make a change in the plan of care, can the G9008 be billed for that conversation?

A: This would be a G9007.

S0257: End-of-Life Counseling

Q: Can a care team member bill for advance care planning conversations?

A: Yes, care team members who conduct end-of-life (advance care planning) conversations with either the patient or “surrogate” can bill S0257.

BCBSM-related answers reviewed and approved by Blue Cross Blue Shield of Michigan as of November 4, 2021.

Priority Health-related answers reviewed and approved by Priority Health as of November 7, 2021.
Michigan Institute for Care Management and Transformation
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Ann Arbor, MI 48105

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Disclaimer Statement: Although Blue Cross Blue Shield of Michigan and MICMT work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.

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