Description: A discussion between the managing provider and one or more care-team members addressing details related to individualized care plan and goal achievement
Delivery Method: Face-to-face, telephone, or via video
Who Can Bill? Physician or APP
| Payer | Billing Allowance | Requirement |
| BCBSM/BCN/BCN Advantage |
No quantity limits Code may be billed one per patient, per practitioner, per day |
The patient is not included 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 | Code can be billed one time per day | |
| Medicaid (varies by HMO) | Limited to once per month (30-60 minutes) |
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.
Recommended Documentation
- Date, time, and duration of discussion for individual patient
- Name and credentials allied professionals present for team conference
- Must minimally include PCP and care manager
- Nature of discussion and pertinent details related to individualized care plan and goal achievement
- Any revisions to care plan goals, interventions, and target dates
- Documented outcomes and agreed upon next steps
*Can be documented by care-team member
G9007 FAQs
For additional PDCM FAQs, please click here
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.
Q: Can the G9007 be billed the same day as the primary care office visit?
A: Yes.
G9007 Scenario
Licensed care-team member completes a comprehensive assessment, assists patient with developing SMART goals. Provides various community resources addressing barriers identified.
Care-team member and patient discuss care plan and follow up with the provider. Provider agrees with the care plan.
Care-team member documents outcomes and agreed-upon next steps.