CPT-G0506

It could also be appropriate to bill G0506 when the initiating visit addresses problems unrelated to CCM, and the billing practitioner does not consider the CCM-related work he or she performs in determining what level of initiating visit to the bill. We believed that this proposal would more appropriately recognize the relative resource costs for the work of the billing practitioner in initiating CCM services, specifically for extensive work assessing the beneficiary and establishing the CCM care plan that is reasonable and necessary, and that is not accounted for in the billed initiating visit or in the unit of the CCM service itself that is billed for a given service period. In addition, we believed this proposal would help ensure that the billing practitioner personally performs and meaningfully contributes to the establishment of the CCM care plan when the patient’s complexity warrants it.”

The physician must personally develop the care plan for all health conditions and the work should go well beyond the typical work of the related initiating visit (e.g., an AWV is estimated to have 10 minutes of post-service time so 30 minutes spent in care planning, in addition, the AWV could be considered extensive).