Guidelines to Submit a Claim for Care Plan Oversight
Physicians spend valuable time coordinating care for terminally ill patients and their caregivers. Care plan oversight (CPO) is a service for which certain clinicians¹ can bill Medicare in the absence of a face-to-face patient encounter. Many providers coordinate care as required, but do not submit a claim. They are losing deserved revenue².
- The beneficiary requires complex or multidisciplinary care modalities that call for ongoing clinician involvement in the plan of care
- CPO is furnished during the period in which the beneficiary received Medicare-covered hospice services
- The clinician who billed for CPO is the clinician who signed the hospice plan of care
- The clinician provided at least 30 minutes of CPO within the calendar month for which payment is claimed
- The clinician provided a covered physician service that required a face-to-face encounter with the patient within six months of billing for the CPO
- Only one clinician per month billed for CPO
- The clinician did not bill Medicare for an end-stage renal disease (ESRD) capitation payment for the same beneficiary during the same month
- Regular physician development and/or revision of care plans
- Review of subsequent patient status reports
- Review of related laboratory and other studies
- Communication with health professionals not employed in the same practice who are involved in the patient’s care
- Integration of new information into the medical treatment plan
- Adjustment of medical therapy
Use Healthcare Common Procedure Coding System (HCPCS) code G0182 when CPO is provided to patients who have elected hospice from a Medicare-approved hospice provider.
1Physicians, nurse practitioners, clinical nurse specialists and physician assistants.
2Palmeter, MC. “Take a Closer Look at Care Plan Oversight.” American Academy of Professional Coders. https://www.aapc.com/ blog/27473-take-a-closer-look-at-care-plan-oversight/
3Medicare Benefit Policy Manual Chapter 15 – Covered Medical and Other Health Services. (Rev. 228, 10-13-16) https://www.cms. gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ bp102c15.pdf
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