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New Billing Codes Further Encourage Effective Chronic Care Management

Centers for Medicare and Medicaid Services (CMS) is now reimbursing for all the time needed to provide non-face to face care coordination. There are now 99490, 99487 and 99489 (allowing billing for 20 minutes, 60 minutes and additional 30 minutes respectively). While 99490 is specifically Chronic Care Management, the latter two are for Complex Chronic Care Management, intended to deal with only very complex, specific patients.


Additionally, Behavioral Health Integration (BHI) will be added. Included under this term are information sharing, discussions, and planning between a primary care provider and a behavioral health specialist regarding the treatment and management of a patient with behavioral health conditions. CMS will pay separately for services using the CoCM (Collaborative Care) beginning January 1, 2017 using three new G-codes: G0502, G0503, and G0504. These codes describe the requirements for initial and subsequent collaborative care management involving a behavioral healthcare manager under the direction of the patient’s treating physician working with a psychiatric consultant.


CMS outlines:


  • Mental and Behavioral Health: CMS is proposing to pay for specific behavioral health services furnished using the Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also proposing to pay more broadly for other approaches to behavioral health integration services.
  • Cognitive Impairment Care Assessment and Planning: CMS is proposing a new code to pay for cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s). This is a major step forward for care planning for these populations.


CMS payment for code G0502 is for care management services for behavioral health conditions in primary care settings. The requirements for this code are the same as those for chronic care management, with the exception of the qualifying diagnosis. The proposed reimbursement for G0503 is roughly $3.00 more than the reimbursement for 99490, with the increase intended to cover the additional resources required for behavioral health care.

Since the changing healthcare landscape ties reimbursement to greater value provided, it is a smart choice to implement a care management plan that will no doubt enhance a practice’s value-based initiatives into the future. The results of increased revenue and better care clearly justify investing a small amount in any additional staff and technology needed.

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