Care management billing
Care management billing for monthly programs
Billing support for CCM, Complex CCM, CPO, RPM, PCM and behavioral health integration. A claim goes out once the record shows the requirements were met.
It's free, and you can keep your current biller
The rules behind monthly care programs
Care management codes come with consent requirements, time thresholds, supervision rules, care plans and limits on which codes can be billed together. A nurse can spend the whole month calling a patient, but if the time wasn't logged or consent isn't on file, that month can't be billed.
Billing without all of that in place creates repayment risk, and you might not hear about it until an audit. Your clinical team does the care, and we check that the record supports the claim before it goes out.
Programs we support
- Chronic care managementCodes such as 99490, 99439 and 99491, for patients with two or more chronic conditions that meet the program's criteria.
- Complex chronic care managementCodes such as 99487 and 99489, when moderate to high complexity decision making and the required time are documented.
- Care plan oversightG0181 for physician or allowed practitioner oversight of home health patients, and G0182 for physician oversight of hospice patients.
- Remote physiologic monitoringCodes such as 99453, 99445, 99454, 99470 and 99457. Device days and management time have their own requirements.
- Principal care managementCodes 99424 to 99427, for a single high risk condition.
- Behavioral health integrationCodes such as 99484, when the program requirements are met.
How it runs
- 1
Check prerequisites first
We confirm consent and eligibility from your records, and we check the care plan's status.
- 2
Review the month
We check the recorded time and look for duplicate or incompatible billing.
- 3
Prepare claims for review
Claims that meet the rules get prepared. Anything that doesn't meet them comes back to you.
How this is priced
Care management billing administration is either included in your billing fee or negotiated separately, depending on the program and its volume.
How our pricing worksCare management billing questions
What people ask about this
Do you provide the care or the clinical staff?
No. Fieldstone provides billing and administrative support. The clinical services, time, documentation and supervision stay with your practice.
Will you create documentation to support a claim?
No. If the required time or documentation isn't in your record, the service doesn't get billed.
Are these codes current?
They change, so don't rely on this page alone. Codes and reimbursement rules move each year and vary by payer, and we check them against the current year's guidance before billing.
Can we add these programs later?
Yes, and it's generally easier to get your core billing settled first, then add the programs that suit your patients and staffing.
Related services
Find out what your claims are leaving behind
Send us your denial and A/R reports and you'll have a written report within 48 hours, for free. You can keep your current biller while you decide.
