Part of Chronic Care Management
HCPCS G0506: Comprehensive care plan, CCM initiating visit add-on
One-time add-on to the qualifying face-to-face visit that formally establishes a patient in Chronic Care Management, covering the extra work of assessment and care plan development.
Time threshold & code combinations
Billed once, at the visit that initiates CCM, not recurring monthly.
- Billed once per patient's CCM enrollment, not billed again alongside the monthly CCM codes (99490, 99491, 99487, etc.)
Who can bill
- Physicians and non-physician practitioners who can bill E/M services
Eligibility & billing requirements
- Patient is new to CCM with the billing practitioner or practice
- Billed in conjunction with a qualifying face-to-face E/M visit (such as an Annual Wellness Visit or other qualifying visit) where CCM is first discussed and consented to
- Personally performed by the billing physician/QHP, not delegated to clinical staff
- Documentation of the additional assessment and care plan development work performed at that visit
When to use it
Identifying a new CCM candidate at an Annual Wellness Visit
During an Annual Wellness Visit, a physician identifies a patient with two qualifying chronic conditions, discusses CCM, obtains consent, and personally develops the initial comprehensive care plan.
Billing: AWV code + G0506
Documentation checklist
- Consent obtained at the visit
- Initial comprehensive care plan documentation
- Note tying G0506 to the specific qualifying visit
Common billing mistakes
- Billing G0506 repeatedly instead of only at the true initiating visit
- Billing G0506 without a qualifying face-to-face visit on the same date