Specialty Billing Built for Geriatrics Practices

Chronic Care Management 99490 is billed once per calendar month per patient with two or more chronic conditions expected to last at least 12 months, requiring at least 20 minutes of clinical staff time directed by a physician that month, plus a documented care plan. The 99439 add-on is billed for each additional 20 minutes of care management beyond the base. Complex CCM (99437) is billed in 30-minute increments for higher-complexity patients. Time must be logged and the care plan accessible. We validate the monthly time log and care-plan documentation before billing each CCM month, and capture 99439 add-ons whenever the documented time exceeds 20 minutes — the most common way CCM revenue is lost.

BHI is billed under a psychiatric collaborative care model or behavioral care management framework. 99484 is the base BHI code for behavioral health integration, with 99492 billed for the first 70 minutes of behavioral care management in the first month, 99493 for the first 60 minutes in months 2-6, and 99494 as an add-on for each additional 30 minutes. BHI can be stacked alongside CCM when the patient has both chronic medical and behavioral conditions, because BHI addresses the behavioral pathway separately. We document behavioral care-management time and the psychiatric clinical pathway so BHI is captured alongside CCM rather than absorbed into the CCM time.

Cognitive impairment assessment (99483) is billed for a 60-minute clinical visit that includes a cognitive assessment, development of a care plan, and discussion with the patient and/or caregiver. It is typically billed once per patient and requires documentation of all three components — assessment, care plan, and caregiver input. It supports dementia ICD-10 codes (F01 vascular dementia, F03 unspecified dementia, G30 Alzheimer's) and R54 age-related cognitive decline. We use documentation templates that capture the assessment tool used, the care plan, and the caregiver discussion so the full 99483 requirements are met rather than documenting cognition informally and leaving the code unbilled.

Transitional Care Management is billed once per 30-day post-discharge period per patient. 99496 (high complexity) requires an interactive contact within 2 business days of discharge and a face-to-face visit within 7 days of discharge. 99495 (moderate complexity) requires an interactive contact within 2 business days and a face-to-face visit within 14 days of discharge. Both require medication reconciliation and a non-face-to-face care-management component. We ingest the discharge feed to trigger visit-window alerts, capture medication reconciliation, and ensure the F2F visit is scheduled within the code-specific window so TCM is billed rather than missed when the visit slips outside the period.

Advance care planning 99497 is billed for the first 30 minutes of a face-to-face conversation between the physician and patient (and/or caregiver) about goals of care, advance directives, and end-of-life preferences. 99498 is the subsequent add-on for each additional 30 minutes. It can be stacked with the AWV, cognitive assessment 99483, or a problem E/M (with modifier 25 where required) when the goals-of-care discussion is separately documented. Medicare allows voluntary advance care planning as a separate service. We document the time, the discussion content, and the resulting plan so 99497 is captured whenever goals-of-care conversations occur — frequently delivered but rarely billed without dedicated documentation.