Description: A focused discussion between the patient and/or caregiver related to the patient's care plan (progress changes)
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
For visits > 45 minutes, bill quantities:
Can be done via telephone (note: telephone can only be utilized if video was declined by patient)
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.
BCN/BCN MA - PCMH Designated Primary Care Providers only. Specialist not eligible at this time.
2P modifier included when contact is completed with patient to discuss program and patient does not enroll in care management services (specific to commercial PPO members only)
|Priority Health||Code can be billed once per day||Must include patient|
|Medicaid (varies by HMO)||Must be at least 30 minutes, limit once per month||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.
- Date of service
- Duration and mode of contact (face-to-face or video)
- Name and credentials of person delivering services
- Individuals in attendance other than patient and relationship to patient
- All active diagnoses
- Treatment plan, self-management education, medication therapy, risk factors, unmet care, physical/emotional status, community resources/referrals,
- Readiness to change
- Care plan updates – progress to goal
- Patient/family/caregiver understanding and agreement to plan
- Physician coordination activities (if available)
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, a coordinated care visit is >45 minutes, you may quantity bill. A G9001 cannot be quantity-billed.
Q: Can a care-team member use the same ICD-10 code selected by the physician to bill the G9002 maintenance visit?
A: Yes, the ICD-10 Code is appropriate for the focused discussion provided