Description: Initiation of care management services (Comprehensive Assessment) and comprehensive (focused) care plan
Delivery Method: Face-to-face or via video
Who Can Bill? Any licensed care-team member who has completed Introduction to Team-Based Care within 6 months of billing
Once per patient, per day, per practice
Can be done via telephone (note: telephone can only be utilized if video was declined by patient)
On 9/20/23, BCBSM communicated providers recognized as registered dietitians with the education to support that recognition can bill in person PDCM codes (as if they are licensed).
For groups not participating in the PDCM program, if claim is submitted, it will deny as MEMBER liable. For all other groups, a claim is submitted and denies, it will deny as PROVIDER liable.
|Priority Health||Limited to once per practice annually||Must include patient. Work must encompass a minimum of 30 minutes, some of which maybe without the patient present|
|Medicaid (varies by HMO)||Limited to once per year with same diagnosis; cannot be billed in the same month as G9002||Must be a face-to-face encounter|
Billing opportunities and reimbursement may vary depending upon organization's specific payer value-based contracts. All services should be billed in accordance with CPT and Center for Medicare & Medicaid service guidelines.
MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors.
- Identify care manager responsible for overall care plan, his/her credentials, and patient’s provider and contact information
- Date, duration, and modality of contact (face-to-face or video)
- Name and relationship of person contacted if other than patient
- All active diagnoses assessed (and reported on claim)
- Current physical and mental/emotional status
- Current medical treatment regimen and medications
- Risk factors
- Available resources and unmet needs
- Level of patient’s understanding of condition and readiness for change
- Perceived barriers to treatment plan adherence
- Individualized long and short-term desired outcomes and target dates
- Anticipated interventions and timeframe for follow-up
- Patient consent to engage/participate in care management
For additional PDCM FAQs, please click here
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?
Q: Can the initial assessment (G9001) be billed if the patient decided not to proceed with care management services?
Q: Can a pharmacist bill a G9001?
A: Yes, a pharmacist is a licensed care-team member in the state of Michigan
The MD refers the patient with a BMI for age >95%ile. Upon working with the patient, there are identifiable nutrition goals the patient would like to work on. However, the RD feels there is opportunity for this patient to work with Social Work to best address some barriers to optimal success with nutrition goals, so talks with patient and Social Work. This results in the RD referring the patient to SW for an appointment the following week. The RD fills the Social Worker in on progress from the initial RD visit and feels Social Work’s involvement will support the patient in being successful with nutrition-related goals.
- RD and SW are working toward the same goal of supporting the patient to be successful with nutrition-related goals, with the optimal outcome of addressing the BMI for age >95%ile.
- This is focused communication and coordination among two care managers to support patient goals.