This post has been updated to reflect changes in CPT and HCPCS codes for 2018. The original post from December 2016 was titled "New G codes 2017 | Behavioral health management (BHI)" This updated quick reference sheet includes the description for each code, time requirements, reimbursement rates and more. Download PDF Original Post: The CMS Final Rule released in November 2017 included new HCPCS codes for behavioral health … [Read more...]
Intensive behavioral counseling for cardiovascular disease, HCPCS code G0446
Medicare pays a primary care physician or other primary care practitioner in a primary care setting to annually provide one face-to-face behavioral counseling session. The code is defined as 15 minutes. In order to bill these, the record must show that the service took over half of the threshold time, or 7 ½ minutes. All Medicare patients are eligible for the service. The Medicare national payment amount is about $26. G0446 Annual, … [Read more...]
Other new proposals in the 2019 Proposed Physician Fee Schedule Rule
This is the second CodingIntel post about CMS proposed changes to the 2019 Physician Fee Schedule rule. If you missed it, be sure to read the first post: CMS proposes significant changes to E/M requirements We are in the comment period, and the final rule will be released in early November. Just a reminder that all of the new HCPCS and CPT codes discussed in the rule are “dummy” codes, placeholders for the codes to be released. In … [Read more...]
CMS Proposed Changes in the 2019 Physician Fee Schedule Rule | Webinar
Recorded August 16, 2018 Some Fee Schedule rules are almost boring, but not this year! CMS is proposing significant changes to the payment of and documentation for new and established patient visits. This will be a sea change for most groups, particularly groups that use RVUs for physician compensation or that have coders coding all E/M services. CMS is proposing an effective date of January 1, 2019, but asking for comments about … [Read more...]
CMS proposes significant changes to E/M requirements
By now, you’ve read the headlines that CMS is proposing major changes to both the documentation requirements for new and established patient visits and the payment structure for the services. I’ll try to go beyond the headlines in this post, and tell you what CMS is proposing. Of course, we know that CMS puts together proposals every year for the payment policy for the coming year. Right now we are in a comment period for these policies. … [Read more...]
Screening for depression | HCPCS code G0444
Annual depression screening code G0444 Medicare pays primary care practices to screen all Medicare patients annually for depression. The service must be provided in a primary care setting, in place of service office, outpatient hospital, independent clinic or in a state or local health department. This service is paid using HCPCS code G0444, annual depression screening, 15 minutes. The reimbursement is relatively low, about $26 for the … [Read more...]
Behavioral counseling for obesity, HCPCS code G0447
Medicare pays for ongoing face-to-face behavioral counseling for patients with a BMI of ≥ 30, who are alert and able to participate in counseling. The service may be performed by physician or non-physician practitioner (NPP) , but is also allowed to be performed buy medical practice staff incident to the services of a physician or an NPP. The national Medicare fee schedule amount is about $26. G0447 face-to-face behavioral counseling for … [Read more...]
Prolonged services codes for Medicare preventive medicine services: G0513, G0514
Update February 28, 2018 The first chart I posted with this article had an error. Thanks to the sharp eyed member who found my error and pointed it out. We've posted the corrected chart. Someone asked where to find the CMS chart with the intraservice guidelines. It is hidden deep on the CMS site! It is in the files that go with the 2018 Final Rule. Scroll down to about the 20th on the list and download 2018 List of Preventive Services Billed … [Read more...]
Coding changes for 2018 | Webinar
Recorded February 15, 2018 Listen in on this high level overview of new CPT and HCPCS codes for 2018! Every year, the AMA updates the CPT code set and CMS updates the HCPCS code set. This year, some 2017 HCPCS codes were changed to 2018 CPT codes. This webinar will describe the changes in both code sets so your practice will be ready. If you look at Appendix B of the CPT book, there is a list of additions, deletions and revisions in the … [Read more...]
G0101 Pelvic and Breast Exam
Medicare does not pay for routine physical exams annually for patients - a sore spot for gynecologists, primary care providers and Medicare beneficiaries alike. They do pay for an initial Welcome to Medicare visit, an initial wellness visit and subsequent wellness visits. The wellness visits are usually done by family physicians, internists and geriatricians, and less frequently by gynecologists. Medicare does pay for a screening pelvic and … [Read more...]
Care Management for Behavioral Health Conditions
Care Management for Behavioral Health Conditions Overview CMS developed HCPCS G0507 code for care management performed by clinical staff for patients with behavioral health conditions. Explanation This service describes care management by clinical staff members for patients with behavioral health conditions. It is a non-face-to-face service, and the 20-minutes of time in the calendar month may be provided by the physician/NPP or clinical … [Read more...]
New modifier for telemedicine in 2017: modifier 95
An Overview of Telemedicine Modifier 95: The American Medical Association added a new modifier, symbol and Appendix to CPT in 2017; Modifier 95 Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System. Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the … [Read more...]
New Revenue Opportunities for Primary Care in 2017
2017 brings primary care new revenue opportunities when providing care coordination services, including non-face-to-face prolonged services. There are two new HCPCS codes, in 2017 that describe services primary care practices are doing but not getting paid for. 2017 brings payment for assessing cognitive function and initiation of chronic care management. CMS has also eased the requirements for performing and billing chronic care management and … [Read more...]
How Physician Services are Paid – Infographic
CPT Codes for Medical Reimbursement CPT codes, HCPCS, modifiers, global surgical packages, CMS formulas, diagnosis codes, location, and more...how do all these pieces come together for medical reimbursement? This helpful infographic from CodingIntel shows how physician services are paid with proper medical billing and coding. … [Read more...]
How Physician Services are Paid
Have a new staff member or physician who needs a primer on "how physician services are paid?" This short video is a must see! Learn how all the pieces come together, from CPT and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes... … [Read more...]
High Intensity Behavioral Counseling to Prevent Sexually Transmitted Illnesses
CMS covers counseling to prevent STI in certain circumstances. The code is G0445. G0445 – Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to- face, includes education skills training & guidance on how to change sexual behavior, 20-30 minutes. The patient must be referred by a primary care provider to be eligible to receive this service, according to Medicare. Physicians, advanced practice nurses and … [Read more...]