Care Coordination Services
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Defines Florida Blue's reimbursement stance for care coordination services reported on CMS-1500 or equivalent claims; applies to all lines of business and providers billing Florida Blue.
HCPCS codes G0179-G0182, G0506, and S0311 were added to the Billing/Coding Information section.
Coverage Stance
Coverage stance for care coordination services
Florida Blue's reimbursement stance for care coordination services reported on claims.
Billing and Code Guidance
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with |
| G9001 | Coordinated care fee, initial rate |
| G9002 | Coordinated care fee, maintenance rate |
| G9006 | Coordinated care fee, home monitoring |
| S0280 | Medical home program, comprehensive care coordination and planning, initial plan |
| S0311 | Comprehensive management and care coordination for advanced illness, per calendar month |
Authorization and Applicability
Policy is not authorization or guarantee of payment
This payment policy is not an authorization, certification, explanation of benefits, or a guarantee of payment; benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. The policy applies to all lines of business and providers of service.
Definitions
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