Advanced Applications of Home-Based Primary Care-Virtual Workshop-HCCI Superbill

HCCI Superbill_2021

Pdf Summary

The document provides a comprehensive breakdown of various medical services categorized by location of service (DOM for domiciliary and HOME for home visits), including both initial and established patient visits. The document lists these services with their respective Current Procedural Terminology (CPT) codes for 2021, Work Relative Value Unit (wRVU) assignments, 2021 Medicare Non-Facility Rates, and Medicare allowable rates at 85% for Nurse Practitioners (NP) and Physician Assistants (PA).<br /><br />Key details for each category include:<br /><br />1. **Initial and Established Visits:**<br />    - Ranges from Level 1 (problem-focused history & exam, straight-forward medical decision making (MDM)) to Level 5 (comprehensive history & exam, high MDM).<br />    - Each level has a corresponding CPT code, wRVU, Medicare rate, and NP/PA rate.<br />   <br />2. **Prolonged Services:**<br />    - CPT codes for services exceeding typical visit durations are listed, with specific rates for both face-to-face and non-face-to-face time.<br /><br />3. **Care Plan Oversight (CPO) and Chronic Care Management (CCM):**<br />    - Includes services for Home Health, Hospice, traditional and complex chronic care management, with specific CPT and G codes.<br />    - Different durations (20, 30, or 60 minutes) and tiers (standard or complex) are reflected in rates.<br /><br />4. **Behavioral Health and Transitional Care Management:**<br />    - Codes for behavioral health integration, transitional care management post-discharge, cognitive assessments, and advanced care planning.<br />   <br />5. **Specialized Patient Management:**<br />    - Functions like anticoagulation management, remote evaluations, telephone and digital evaluations, and smoking cessation counseling.<br /><br />6. **Skilled Nursing Facility (SNF) Care:**<br />    - Includes initial and subsequent care, with durations ranging from 10 minutes to over 30 minutes, as well as discharge service codes.<br /><br />7. **Procedures:**<br />    - CPT codes cover common procedures like catheter insertion, cerumen removal, joint injections, punch biopsies, and various forms of debridement and abscess I&D.<br /><br />This structured approach allows healthcare providers to swiftly reference appropriate codes and rates for a wide variety of services, thereby optimizing billing accuracy and ensuring compliance with Medicare reimbursement guidelines.

Keywords

medical services

CPT codes

wRVU assignments

Medicare rates

initial visits

prolonged services

chronic care management

behavioral health

transitional care

procedures