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
|BCBSM||No quantity limits||
The patient is not included
Provider liability if patient does not have the care management benefit
|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.
- 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
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.
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.