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CCM/PCM services
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1/18/2021 @ 3:41:00 PM
Post 1 of 4

Contributor: Sheila Goethel, Rural Wisconsin Health Cooperative

Announced in the 2021 Final MPFS rule, Principal Care Management services (one high-risk or complex condition) are included in the payment for G0511 (RHC general care mgmt, 20 minutes/mo).  PCM HCPCS codes G2024 and G2025 are both described as 30 minutes of care/mo; however, G0511 HCPCS is described as 20 minutes of care/mo.  

Can anyone advise if/when PCM is conducted in an RHC (now billed with G0511), must 30 minutes/mo be extended, OR because it now falls under the purview of G0511, can only 20 minutes be provided for a billable service?  Final Rule did not clarify so I'm assuming the latter, but would like validation.  

Thank you in advance for your input.

 

1/18/2021 @ 4:08:00 PM
Post 2 of 4

Contributor: Jackie King, ArchProCoding

Hi Sheila,

I agree with your reasoning and would make sure that the documentation for the service you are providing/billing with the G code matches the requirements of that CPT code(s). I haven't seen anything to the contrary either.

Thanks,
Jackie

[cid:image001.png@01D579EB.4BFCECC0]

Jackie King, MSHI, CPC, COC, CRHCP, RH-CBS
Director of Compliance & Clinical Informatics, HIM Consultant
Illinois Critical Access Hospital Network (ICAHN) | 1945 Van's Way, Princeton, IL 61356
P 815.875.2999 | F 815.875.2990 | jking@icahn.org | www.icahn.org



1/21/2021 @ 4:57:00 PM
Post 3 of 4

Contributor: Kim Keating, Nursery Street Family Care Clinic

The G0511 code can be used for patients who have agreed to accept PCM services if 30 minutes or more of care management services are logged during the month.

 The G0511 code can be used for patients who have agreed to accept CCM services if 20 minutes or more of care management services are logged during the month.

Same code, same rate, with the difference being that if the patient only has one qualifying condition (PCM), they require 30 minutes of care management services before the code can be billed.

1/22/2021 @ 10:09:00 AM
Post 4 of 4

Contributor: cathy.harte@sih.net

Does anyone have a link to the final rule for PCM?

Cathy L. Harte, CMPE
SIH Medical Group
Regional Practice Director
618.993.3300 office
618.214.8244 mobile


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