G0181 Tips: Oversight codes represent 30 minutes of care plan coordination in one calendar month (e.g. reading labs, communicating with nurses and therapists, research & decision-making, etc.). To avoid retraction of payment, the physician should make notes in the patient’s chart about oversight-related activities and the time invested. The 30 minutes need not be all at once. It can be the sum of time invested over one calendar month. For best results, bill oversight during the month following the dates of service. The physician billing for oversight must be the same physician signing the plans of care. Services covered under G0180 and G0179 cannot be counted toward G0181.
CPT 99495 and CPT 99496 = Transitional Care Management
When these codes were first launched, the Centers for Medicare & Medicaid Services predicted that family practitioners who use them would see a 7% increase in overall reimbursement from Medicare! These codes pay doctors for one office visit occurring within seven or fourteen days of a hospital discharge with a large bonus for medication reconciliation and all the work of coordinating other outpatient care such as home health, hospice, pharmacists, other doctors, etc. Reimbursement can be well over $200. Five Star Home Health skilled nurses will provide medication reconciliation and skilled staff will assist patients to schedule appointments with PCPs post hospital discharge. This code is meant to incentivize offices to call patients right after a hospital discharge and get them in for an office visit. It essentially describes a program for transitional care management that is largely what most doctors do anyway.
CPT 99490 = Chronic Care Management Services
Medicare’s approval of CPT 99490 has the potential to add thousands of dollars to the bottom line of practices by reimbursing prescribers for work they and their staff have likely been doing without real compensation for decades. CPT 99490 covers doctor and clinical staff time for non-face-to-face care coordination services with other healthcare providers such as Five Star Home Health. Five Star Home Health nurses and therapists provide a strong force for preventive care covered under CPT 99490. Home health skilled nurses and therapists communicate significant changes in patients’ conditions to physician and other healthcare providers. CPT 99490 covers at least 20 minutes of clinical staff time per calendar month coordinating care with other providers for Medicare beneficiaries with two or more chronic conditions. Physicians, physician assistants, nurse practitioners, certified nurse midwives, and certified nurse specialists may bill 99490 which does cover the time of other clinical staff operating under the prescriber’s direction. Medicare will pay roughly $126 per hour.