Data Updated for Q4 2018
CPT Code: 99497
Description: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
Status Code
A
Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a nation
Global Days
XXX
The global concept does not apply to the code.
Medicare RUVs and Fees
Work RVU – 1.50
Malpractice RVU – 0.10
Facility RVU – 0.64
Non-Facility RVU – 0.79
Facility Total RVU – 2.24
Non-Facility Total RVU – 2.39
Medicare National Facility Total Payment – $80.64
Medicare National Non-Facility Total Payment – $86.04
Bundling Information
Includes
0359T, 0360T, 0361T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T, 0373T, 0374T, 0469T, 36591, 36592, 43752, 80500, 80502, 90863, 90940, 92002, 92004, 92012, 92014, 92227, 92228, 92531, 92532, 93561, 93562, 93792, 93793, 94002, 94003, 94004, 94660, 94662, 95831, 95832, 95833, 95834, 95851, 95852, 96020, 96101, 96102, 96103, 96105, 96116, 96118, 96119, 96120, 96125, 96150, 96151, 96152, 96153, 96154, 96155, 96523, 97802, 97803, 97804, 99172, 99173, 99174, 99177, 99408, 99409, 99446, 99447, 99448, 99449, 99605, 99606, G0102, G0117, G0118, G0245, G0246, G0248, G0250, G0270, G0271, G0396, G0397, G0442, G0443, G0444, G0445, G0446, G0447, G0459, G0473, G0473, G0505
Included In
00100, 00100, 00102, 00102, 00103, 00103, 00104, 00104, 00120, 00120, 00124, 00124, 00126, 00126, 00140, 00140, 00142, 00142, 00144, 00144, 00145, 00145, 00147, 00147, 00148, 00148, 00160, 00160, 00162, 00162, 00164, 00164, 00170, 00170, 00172, 00172, 00174, 00174, 00176, 00176, 00190, 00190, 00192, 00192, 00210, 00210, 00211, 00211, 00212, 00212, 00214, 00214, 00215, 00215, 00216, 00216, 00218, 00218, 00220, 00220, 00222, 00222, 00300, 00300, 00320, 00320, 00322, 00322, 00326, 00326, 00350, 00350, 00352, 00352, 00400, 00400, 00402, 00402, 00404, 00404, 00406, 00406, 00410, 00410, 00450, 00450, 00454, 00454, 00470, 00470, 00472, 00472, 00474, 00474, 00500, 00500, 00520, 00520, 00522, 00522, 00524, 00524, 00528, 00528, 00529, 00529, 00530, 00530, 00532, 00532, 00534, 00534, 00537, 00537, 00539, 00539, 00540, 00540, 00541, 00541, 00542, 00542, 00546, 00546, 00548, 00548, 00550, 00550, 00560, 00560, 00561, 00561, 00562, 00562, 00563, 00563, 00566, 00566, 00567, 00567, 00580, 00580, 00600, 00600, 00604, 00604, 00620, 00620, 00625, 00625, 00626, 00626, 00630, 00630, 00632, 00632, 00635, 00635, 00640, 00640, 00670, 00670, 00700, 00700, 00702, 00702, 00730, 00730, 00731, 00732, 00740, 00740, 00750, 00750, 00752, 00752, 00754, 00754, 00756, 00756, 00770, 00770, 00790, 00790, 00792, 00792, 00794, 00794, 00796, 00796, 00797, 00797, 00800, 00800, 00802, 00802, 00810, 00810, 00811, 00812, 00813, 00820, 00820, 00830, 00830, 00832, 00832, 00834, 00834, 00836, 00836, 00840, 00840, 00842, 00842, 00844, 00844, 00846, 00846, 00848, 00848, 00851, 00851, 00860, 00860, 00862, 00862, 00864, 00864, 00865, 00865, 00866, 00866, 00868, 00868, 00870, 00870, 00872, 00872, 00873, 00873, 00880, 00880, 00882, 00882, 00902, 00902, 00904, 00904, 00906, 00906, 00908, 00908, 00910, 00910, 00912, 00912, 00914, 00914, 00916, 00916, 00918, 00918, 00920, 00920, 00921, 00921, 00922, 00922, 00924, 00924, 00926, 00926, 00928, 00928, 00930, 00930, 00932, 00932, 00934, 00934, 00936, 00936, 00938, 00938, 00940, 00940, 00942, 00942, 00944, 00944, 00948, 00948, 00950, 00950, 00952, 00952, 01112, 01112, 01120, 01120, 01130, 01130, 01140, 01140, 01150, 01150, 01160, 01160, 01170, 01170, 01173, 01173, 01180, 01180, 01190, 01190, 01200, 01200, 01202, 01202, 01210, 01210, 01212, 01212, 01214, 01214, 01215, 01215, 01220, 01220, 01230, 01230, 01232, 01232, 01234, 01234, 01250, 01250, 01260, 01260, 01270, 01270, 01272, 01272, 01274, 01274, 01320, 01320, 01340, 01340, 01360, 01360, 01380, 01380, 01382, 01382, 01390, 01390, 01392, 01392, 01400, 01400, 01402, 01402, 01404, 01404, 01420, 01420, 01430, 01430, 01432, 01432, 01440, 01440, 01442, 01442, 01444, 01444, 01462, 01462, 01464, 01464, 01470, 01470, 01472, 01472, 01474, 01474, 01480, 01480, 01482, 01482, 01484, 01484, 01486, 01486, 01490, 01490, 01500, 01500, 01502, 01502, 01520, 01520, 01522, 01522, 01610, 01610, 01620, 01620, 01622, 01622, 01630, 01630, 01634, 01634, 01636, 01636, 01638, 01638, 01650, 01650, 01652, 01652, 01654, 01654, 01656, 01656, 01670, 01670, 01680, 01680, 01682, 01682, 01710, 01710, 01712, 01712, 01714, 01714, 01716, 01716, 01730, 01730, 01732, 01732, 01740, 01740, 01742, 01742, 01744, 01744, 01756, 01756, 01758, 01758, 01760, 01760, 01770, 01770, 01772, 01772, 01780, 01780, 01782, 01782, 01810, 01810, 01820, 01820, 01829, 01829, 01830, 01830, 01832, 01832, 01840, 01840, 01842, 01842, 01844, 01844, 01850, 01850, 01852, 01852, 01860, 01860, 01916, 01916, 01920, 01920, 01922, 01922, 01924, 01924, 01925, 01925, 01926, 01926, 01930, 01930, 01931, 01931, 01932, 01932, 01933, 01933, 01935, 01935, 01936, 01936, 01951, 01951, 01952, 01952, 01958, 01958, 01960, 01960, 01961, 01961, 01962, 01962, 01963, 01963, 01965, 01965, 01966, 01966, 01967, 01967, 01968, 01968, 01969, 01969, 01990, 01990, 01991, 01991, 01992, 01992, 0394T, 0395T, 11720, 11720, 11721, 11721, 36511, 36511, 36512, 36512, 36513, 36513, 36514, 36514, 36515, 36515, 36516, 36516, 37211, 37211, 37212, 37212, 37213, 37213, 37214, 37214, 38206, 38206, 59400, 59400, 59410, 59410, 59425, 59425, 59426, 59426, 59430, 59430, 59510, 59510, 59515, 59515, 59610, 59610, 59614, 59614, 59618, 59618, 59622, 59622, 61645, 77261, 77261, 77262, 77262, 77263, 77263, 77280, 77280, 77285, 77285, 77290, 77290, 77293, 77293, 77295, 77295, 77300, 77300, 77301, 77301, 77306, 77306, 77307, 77307, 77316, 77316, 77317, 77317, 77318, 77318, 77321, 77321, 77331, 77331, 77332, 77332, 77333, 77333, 77334, 77334, 77336, 77336, 77338, 77338, 77370, 77370, 77371, 77371, 77372, 77372, 77373, 77373, 77401, 77402, 77407, 77412, 77417, 77417, 77422, 77422, 77423, 77423, 77424, 77424, 77425, 77425, 77427, 77427, 77431, 77431, 77432, 77432, 77435, 77435, 77469, 77470, 77470, 77520, 77520, 77522, 77522, 77523, 77523, 77525, 77525, 77600, 77600, 77605, 77605, 77610, 77610, 77615, 77615, 77620, 77620, 77750, 77750, 77761, 77761, 77762, 77762, 77763, 77763, 77767, 77768, 77776, 77777, 77778, 77778, 77789, 77789, 77790, 77790, 90460, 90460, 90461, 90461, 90471, 90471, 90472, 90472, 90473, 90473, 90474, 90474, 90791, 90791, 90792, 90792, 90832, 90832, 90834, 90834, 90837, 90837, 90845, 90845, 90846, 90846, 90847, 90847, 90849, 90849, 90853, 90853, 90865, 90865, 90867, 90867, 90868, 90868, 90869, 90869, 90880, 90880, 90935, 90935, 90937, 90937, 90945, 90945, 90947, 90947, 90951, 90951, 90952, 90952, 90953, 90953, 90954, 90954, 90955, 90955, 90956, 90956, 90957, 90957, 90958, 90958, 90959, 90959, 90960, 90960, 90961, 90961, 90962, 90962, 90963, 90963, 90964, 90964, 90965, 90965, 90966, 90966, 90967, 90967, 90968, 90968, 90969, 90969, 90970, 90970, 93015, 93015, 93016, 93016, 93017, 93017, 93018, 93018, 94010, 94010, 94011, 94011, 94012, 94012, 94013, 94013, 94014, 94014, 94015, 94015, 94016, 94016, 94060, 94060, 94070, 94070, 94150, 94150, 94200, 94200, 94250, 94250, 94375, 94375, 94400, 94400, 94450, 94450, 94452, 94452, 94453, 94453, 94610, 94610, 94617, 94618, 94620, 94620, 94621, 94621, 94640, 94640, 94642, 94642, 94644, 94644, 94645, 94645, 94660, 94662, 94664, 94664, 94667, 94667, 94668, 94668, 94669, 94669, 94680, 94680, 94681, 94681, 94690, 94690, 94726, 94726, 94727, 94727, 94728, 94728, 94729, 94729, 94750, 94750, 94760, 94760, 94761, 94761, 94762, 94762, 94770, 94770, 94772, 94772, 94774, 94774, 94775, 94775, 94776, 94776, 94777, 94777, 94780, 94780, 94781, 94781, 95004, 95004, 95012, 95012, 95017, 95017, 95018, 95018, 95024, 95024, 95027, 95027, 95028, 95028, 95044, 95044, 95052, 95052, 95056, 95056, 95060, 95060, 95065, 95065, 95070, 95070, 95071, 95071, 95076, 95076, 95079, 95079, 95115, 95115, 95117, 95117, 95120, 95120, 95125, 95125, 95130, 95130, 95131, 95131, 95132, 95132, 95133, 95133, 95134, 95134, 95144, 95144, 95145, 95145, 95146, 95146, 95147, 95147, 95148, 95148, 95149, 95149, 95165, 95165, 95170, 95170, 95180, 95180, 96111, 96111, 96360, 96360, 96365, 96365, 96369, 96369, 96372, 96372, 96373, 96373, 96374, 96374, 96377, 96401, 96401, 96402, 96402, 96405, 96405, 96406, 96406, 96409, 96409, 96413, 96413, 96416, 96416, 96420, 96420, 96422, 96422, 96425, 96425, 96440, 96440, 96446, 96446, 96450, 96450, 96521, 96521, 96522, 96522, 96542, 96542, 97810, 97810, 97811, 97811, 97813, 97813, 97814, 97814, 98925, 98925, 98926, 98926, 98927, 98927, 98928, 98928, 98929, 98929, 98940, 98940, 98941, 98941, 98942, 98942, 98943, 98943, 99143, 99143, 99144, 99144, 99145, 99148, 99148, 99149, 99149, 99150, 99151, 99152, 99153, 99155, 99156, 99157, 99183, 99218, 99218, 99219, 99219, 99220, 99220, 99221, 99221, 99222, 99222, 99223, 99223, 99224, 99224, 99225, 99225, 99226, 99226, 99234, 99234, 99235, 99235, 99236, 99236, 99238, 99239, 99291, 99291, 99292, 99292, 99304, 99305, 99306, 99455, 99455, 99456, 99456, 99466, 99466, 99468, 99468, 99469, 99469, 99471, 99471, 99472, 99472, 99475, 99475, 99476, 99476, 99477, 99477, 99478, 99478, 99479, 99479, 99480, 99480, 99483, 99485, 99485, 99486, 99486, C8957, C8957, G0101, G0101, G0104, G0104, G0105, G0105, G0106, G0106, G0120, G0120, G0121, G0121, G0302, G0302, G0303, G0303, G0304, G0304, G0305, G0305, G0339, G0339, G0340, G0340, G0410, G0410, G0411, G0411, G0463, G0491, G0492, G0498, G0500, G6002, G6002, G6003, G6003, G6004, G6004, G6005, G6005, G6006, G6006, G6007, G6007, G6008, G6008, G6009, G6009, G6010, G6010, G6011, G6011, G6012, G6012, G6013, G6013, G6014, G6014, G6015, G6015, G6016, G6016, G6017, G6017, P3000, P3000, P3001, P3001, Q0091, Q0091, Q2043, Q2043
Mutually Exclusive
11719, 97001, 97001, 97002, 97002, 97003, 97003, 97004, 97004, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99463, 99463, G0127, G0127, G0337, G0402, G0438, G0439
If you get stuck finding the right Code, take a look at our 5 Ways to Find the Most Appropriate CPT Code.
Related CPT Codes
| CPT Code | Description |
|---|---|
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes |
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes |
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes |
| 99403 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes |
| 99404 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes |
| 99406 | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes |
| 99407 | Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes |
| 99408 | Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes |
| 99409 | Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes |
| 99411 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes |
| 99412 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes |
| 99415 | Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service) |
| 99416 | Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service) |
| 99429 | Unlisted preventive medicine service |
| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| 99444 | Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network |
| 99446 | Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review |
| 99447 | Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review |
| 99448 | Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 21-30 minutes of medical consultative discussion and review |
| 99449 | Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 31 minutes or more of medical consultative discussion and review |
| 99450 | Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with “chain of custody” protocols; and Completion of necessary documentation/certificates. |
| 99455 | Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient’s condition; Performance of an examination commensurate with the patient’s condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. |
| 99456 | Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient’s condition; Performance of an examination commensurate with the patient’s condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. |
| 99460 | Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant |
| 99461 | Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center |
| 99462 | Subsequent hospital care, per day, for evaluation and management of normal newborn |
| 99463 | Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date |
| 99464 | Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn |
| 99465 | Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output |
| 99466 | Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport |
| 99467 | Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; each additional 30 minutes (List separately in addition to code for primary service) |
| 99468 | Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger |
| 99469 | Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger |
| 99471 | Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age |
| 99472 | Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age |
| 99475 | Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age |
| 99476 | Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age |
| 99477 | Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services |
| 99478 | Subsequent intensive care, per day, for the evaluation and management of the recovering very low birth weight infant (present body weight less than 1500 grams) |
| 99479 | Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weight of 1500-2500 grams) |
| 99480 | Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2501-5000 grams) |
| 99483 | Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination; Medical decision making of moderate or high complexity; Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity; Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]); Medication reconciliation and review for high-risk medications; Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s); Evaluation of safety (eg, home), including motor vehicle operation; Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks; Development, updating or revision, or review of an Advance Care Plan; Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver. |
| 99484 | Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team. |
| 99485 | Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes |
| 99486 | Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure) |
| 99487 | Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, establishment or substantial revision of a comprehensive care plan, moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.; |
| 99489 | Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, establishment or substantial revision of a comprehensive care plan, moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) |
| 99490 | Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored. |
| 99492 | Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies. |
| 99493 | Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment. |
| 99494 | Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure) |
| 99495 | Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge |
| 99496 | Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge |
| 99497 | Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate |
| 99498 | Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure) |
| 99499 | Unlisted evaluation and management service |
