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CPT code G0506 – Chronic Care Management Care Planning
CPT code G0506 is an HCPCS add-on code that allows reimbursement for comprehensive care planning and assessment for patients requiring chronic care management (CCM). This code recognizes the extensive work of creating care plans for patients with complex medical conditions.
Key Features of G0506
- Category: Care Management Services
- Code Type: Non-timed-based add-on code
- Associated Codes: Can only be billed alongside specific E/M codes (e.g., 99202–99205, 99212–99215, G0402, G0438, G0439).
Billing Guidelines
- G0506 is billed once per patient per calendar month during the initiation of CCM services.
- The care planning must go beyond the usual effort of the related E/M service, such as the Annual Wellness Visit (AWV) or a face-to-face visit.
- The physician must personally perform extensive work, including assessing the patient and developing a comprehensive care plan.
- This code does not apply to behavioral health initiatives (BHI).
When to Use G0506
G0506 is appropriate when the following conditions are met:
- The practitioner conducts significant care planning during the initiating visit.
- The complexity of the patient’s condition warrants extensive assessment and care planning beyond standard E/M services.
Additional Codes Related to CCM
- 99491: For 30 minutes by a physician or other qualified healthcare professional.
- 99487: Covers 60 minutes of clinical staff time.
- 99489: Each additional 30 minutes.
Reimbursement Purpose
This code compensates for the time and effort required to create and implement a patient-specific care plan critical for managing chronic conditions effectively
Frequently Asked Questions (FAQs)
G0506 is a HCPCS Level II code used to bill for Chronic Care Management (CCM) services when at least 30 minutes of clinical staff time is spent per month coordinating care for a patient with multiple chronic conditions. This includes activities like care planning, medication management, and communication with other providers.
Modifiers are not typically required for G0506. However, if billing alongside an Evaluation and Management (E/M) service on the same day, some payers may require Modifier 25 to indicate a separately identifiable service. Always verify payer-specific rules.
G0506 needs two or more chronic situations documented with ICD-10 codes (e.g., diabetes [E11.9], hypertension [I10], COPD [J44.9]). The exact codes depend on the patient’s diagnoses, but they must be active, expected to last ≥12 months, and place the patient at significant risk of complications.
G0560 is used for the Yearly Wellness Visit (AWV) first visit for Medicare patients. It includes a personalized prevention plan, health risk assessment, and screening schedule. Unlike G0506 (CCM), G0560 focuses on preventive care, not ongoing chronic disease management.
Patients qualify for CCM (billed with G0506) if they have:
- Two or additional chronic conditions predictable to last ≥12 months or till death.
- Situations that apartment them at important risk of useful decline or death.
- Agreement to receive CCM services (recognized in their record).
Key Notes
- Documentation is critical: For G0506, track time spent and makes sure patient consent.
- Distinguish G0506 vs. G0560: CCM (ongoing care) vs. AWV (preventive visit).
- Stay updated: Payer policies for modifiers and covered diagnoses can vary.