SOLUTION: Reimbursed Services

Provide Your At-Risk Patient Base with Critical, Medicare Reimbursed Services

content

Medicare supported codes
that expand your care capacity

Chronic disease has become a significant problem. Not just for the patient who is burdened with the symptoms, but also for the provider and health system that are committed to improving outcomes for these patients.

Orb Health's Collaborative Virtual Care™ not only accelerates Chronic Care Management program adoption that significantly improves patient outcomes, and increases reimbursements without additional staff, systems, or offices, but also offers multi-dimensional care across a broad code base. Once you partner with Orb Health you are able to expand your reimbursed care for the existing patient base as it makes sense and without additional resources so your patients get healthier as does your value-based care profitability.

Supported, Medicare Reimbursed Codes

FQHC/Community Health Centers
CPT G0511

FQHCs and RHCs are eligible to provide services such as Transitional care management (TCM), Chronic care management (CCM), General behavioral health integration (BHI), and Psychiatric Collaborative Care Model (CoCM) under this single billing code

Chronic Care Management
CPT 99490

Chronic care management services, at least 20 mins of clinical staff time directed by a physician or other qualified provider, per calendar month

Chronic Care Management
CPT 99491

Chronic care management services, provided personally by a physician or other qualified provider, at least 30 mins of physician or other qualified provider, per calendar month

Complex CCM (cCCM)
CPT 99487

Conditions carry significant risk, require creation/update of comprehensive care plan, moderate/high complexity medical decisions, and 60 mins of clinical staff time per calendar month

Complex CCM (cCCM)
CPT 99489

Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

Remote Patient Monitoring
CPT 99453

CMS covers reimbursement for initial set-up and patient education on the use of equipment for the remote monitoring of physiologic factors like weight, blood pressure, pulse oximetry, and respiratory flow rate

Remote Patient Monitoring
CPT 99454

Covers reimbursement for initial supply and daily recording or programmed alert transmission for a 30-day period for remote devices measuring the same physiologic factors as code 99453

Remote Patient Monitoring
CPT 99457

Covers reimbursement for remote monitoring and management of physiologic conditions, including 20 minutes or more per month of staff time requiring interactive communication with the patient or caregiver

Transition Care Management
CPT 99495

Communication (direct contact, telephone, electronic) with patient and/or caregiver within 2 business days of discharge; moderate or greater medical decision making complexity during the service period; Face-to-face visit, within 14 calendar days of discharge

Transition Care Management
CPT 99496

Communication (direct contact, telephone, electronic) with patient and/or caregiver within 2 business days of discharge; moderate or greater medical decision making complexity during the service period; Face-to-face visit, within 7 calendar days of discharge

Behavioral Health
CPT 99484

At least 20 minutes of clinical staff time per calendar month including initial assessment or follow-ups including use of applicable validated rating scales; care planning in relation to behavioral/psychiatric issues, including revision for patients who are not progressing or whose status changes; treatment facilitation and coordination, and continuity of care with a designated provider

Annual Wellness Visits
CPT G0438

Annual wellness Visit, including a personalized prevention plan of service (PPPS), first visit.

Annual Wellness Visits
CPT G0439

Annual Wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit. Annual Wellness Visits can be for either new or established patients as the code does not differentiate.

Risk and Screening Assessments
CPT 96160

Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument

Risk and Screening Assessments
CPT 96161

Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument

MACRA/MIPS
Compliance

Requires 5 Advancing Care Info, 6 Quality Measures, 4 med / 2 high Improvement Activities. Orb Health Supports 6 Advancing Care Info, 19 Quality Measures, 28 med / 2 high Improvement Activities