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      • G9001: Comprehensive Assessment
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  • PDCM 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
    • PDCM Reference Materials
    • PDCM FAQs
  • CoCM Billing Codes
    • Collaborative Care Services
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    • CoCM Reference Materials
    • CoCM FAQs

PDCM 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

BCBSM distinguishes between licensed and non-licensed individuals.  If an individual is licensed, and they are working within their scope of licensure, then they can bill all the PDCM codes;  (For example,  LPN and LBSW).  If individual is non-licensed and working under their scope of service document, then they can bill the telephonic and care coordination codes only. 

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.

 

BCBSM-related answers reviewed and approved by Blue Cross Blue Shield of Michigan as of July 29, 2022.

Priority Health-related answers reviewed and approved by Priority Health as of November 7, 2021.
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