Does G0506 Need E/M billed with it?

TraciG

New
Local Chapter Officer
Messages
1
Best answers
0
I am getting denials on G0506 being billed alone stating on EOB denial that "This procedure cannot be billed separately" "This service/report cannot be billed separately". Our main coder is stating it can be billed alone per CCM guidelines. Can anyone help? Thank you
 

SharonCollachi

True Blue
Messages
1,761
Location
Clovis, CA
Best answers
3
G0506 is an add-on code. See the MLN article here: https://www.cms.gov/Outreach-and-Ed...NProducts/Downloads/ChronicCareManagement.pdf

Bottom of page 6 and top of page 7:

For new patients or patients not seen within 1 year prior to the commencement of CCM, Medicare requires initiation of CCM services during a face-to-face visit with the billing practitioner (an Annual Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or other face-to-face visit with the billing practitioner). This initiating visit is not part of the CCM service and is separately billed.

Chronic Care Management ServicesMLN BookletICN MLN909188 July 2019Practitioners who furnish a CCM initiating visit and personally perform extensive assessment and CCM care planning outside of the usual effort described by the initiating visit code may also bill HCPCS code G0506 (Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services [billed separately from monthly care management services] [Add-on code, list separately in addition to primary service]). G0506 is reportable once per CCM billing practitioner, in conjunction with CCM initiation.
 
Top