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CPT code G0506 – Chronic Care Management Care Planning

A women and man discuss with chlid sit on the chairs about the health tips professiona use the code for this purpos CPT code G0506

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

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