CPT G0506 – Chronic Care Management Care Planning

As of 2017, Medicare began reimbursing for provider time spent assessing Chronic Care management patients and developing a care plan. Specifically, as of 2022, G0506 reimburses for:

Comprehensive assessment of and care planning by the physician or other qualified health care practitioner for patients requiring CCM services (billed separately from monthly care management services) (Add-on code, list separately in addition to primary service)

G0506 is meant to account specifically for additional work of the billing provider in:

  • Personally performing a face-to-face assessment
  • Personally performing CCM care planning
  • Billing practitioners can bill G0506 only once, as part of initiating visit

Note that this Chronic Care Management care planning could be face-to-face and/or non-face-to-face, but the time spent doing the CCM care planning must not already be reflected in the CCM initiating visit itself or in the time spent during the monthly CCM (i.e., in CPT 99490, CPT 99487, CPT 99489).

The G0506 code is particularly appropriate when the CCM initiating visit is a less complex visit (such as a level 2 or 3 E/M visit). G0506 can be billed along with higher level E&M visits if the practitioner’s effort and time exceeded the usual effort described in the initial visit E&M code. G0506 can also be billed when the initiating E&M visit addresses problems unrelated to Chronic Care Management and the CCM related work is not included in the initial visit code.

G0506 is meant to be billed only once per beneficiary during the initiation of the patient into Chronic Care Management. CMS has updated their language regarding this CPT code as of 2022.

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