HCPCS code G0506: Comprehensive assessment of and care planning for patients requiring chronic care management

Learn more about HCPCS code G0506, how to properly use and bill for the code, and its documentation and billing requirements.

Use Code

## **What is HCPCS code G0506?** HCPCS code G0506 is an add-on chronic care management services code that's used to bill for the extensive work of a physician or other qualified health care professional when performing a comprehensive assessment and care planning for patients requiring CCM services or Chronic Care Management (CCM) services. It's often used so the qualified health care professional goes beyond the "usual effort" described by the initial visit code. The chronic care management code includes evaluating the patient’s clinical status, functional abilities, psychosocial needs, home safety, and support systems. Do note that these services must only be personally performed by the billing practitioner or billing provider and not the clinical staff. Since it's an add-on code, it must be billed in addition to an initiating face-to-face visit, such as an E/M visit, Annual Wellness Visit (AMV), or Initial Preventive Physical Exam (IPPE).

## **G0506 documentation requirements** To justify the use of G0506, the qualified health care professional, nurse practitioner, clinical nurse specialist, physician assistant, etc., must include the following in the patient's medical records: - Extensive face-to-face assessment - Comprehensive care plan that includes a problem list of all health issues, measurable treatment goals, expected outcomes, cognitive/functional assessment, symptom management strategies, planned interventions, medication management, and environmental evaluation - Proof that the assessment and care planning work was extensive and separate from the time and effort of the initiating visit

## **G0506 billing requirements** To ensure proper reimbursement for the services provided, the healthcare provider must consider the following billing requirements: - Must be billed with an initiating visit or qualifying E/M visit, AWV, or IPPE - Patients must have two or more chronic conditions that place them at a significant risk of death, functional decline, etc. - The time and effort documented cannot be counted toward another billed code - Cannot be billed with other services in the same calendar month

## **Other relevant codes** - G0180: Physician or allowed practitioner certification for Medicare-covered home health services under a home health plan of care (patient not present) - G0179: Physician or allowed practitioner re-certification for Medicare-covered home health services under a home health plan of care (patient not present) - G0300: LPN skilled nursing in home health or hospice setting

Frequently asked questions

No, it must be billed with a qualifiying initiating visit.

Yes, G0506 can be billed by a physician or another qualified healthcare professional (QHP), which includes PAs and NPs.

No, G0506 is not a timed code, but the documentation must support that the comprehensive assessment and care planning were extensive and separate from the initiating visit.