Submitting claims for Care Plan reimbursement? Use these codes

August 15, 2014 - Identifying eligible patients and activating the Care Plan are only the beginning steps of the care planning process.

Make sure you remember to review and approve each Care Plan quarterly (or as appropriate).

Why?

Having a dialogue with your patients and tracking their progress along the way is essential for your success in the PCMH Program. Plus, you will be reimbursed for your time for each review.

When submitting claims for reimbursement, be sure to use the following procedure codes for development and maintenance^*:

S0280 - required when developing a Care Plan; reimbursement is $200

S0281- required when maintaining a Care Plan; reimbursement is $100
(Bill this code when substantive changes to the Care Plan occur.)

^*If your patient is enrolled in a high-deductible health plan, certain charges may apply until their deductible is met.

Our Care Plan Guides are available online.

Visit www.carefirst.com/pcmhinfo to find updated versions of the:

• Care Plan Development Guide
• Care Plan Portal User Guide

and additional care coordination materials.