Care management services

Priority Health reimburses, fee for service, for care management services. Reimbursement is available to primary care and specialty physicians. 

Eligible patients

To be enrolled in care management, patients:

  • Are classified as moderate or high risk based on health history
  • Have one or more chronic conditions
  • Have a completed care plan that meets documentation requirements

Reimbursement rates

Find reimbursement rates for the codes listed on this page in our standard fee schedules for your contract. Go to the fee schedules.

Billable care management codes

The CPT and HCPCS manuals define billing and coding requirements for care management services.

When services are performed on the same date as care management services, the care management services should be coded with the appropriate modifier to reflect a significant, separately identifiable service was performed.

Special payment process for some care management codes

Priority Health has a unique process for paying G-code and telephone visit care management services to prevent member cost share for fully funded commercial, Medicare and Medicaid members.

  1. Practices bill care management G-codes and telephone visit CPT services with their practice charges.
  2. Priority Health auto-adjudicates claims, applying a $0 payment.

    On the Remittance Advice, the $0 payment yields full allowed dollars as provider liability.

    The Remittance Advice processing code is either Q11 or CO96, "no compensation allowed for this service - reporting only."

    The member's claim explanation displays $0 member liability. No copayment or deductible applies.

  3. Every 60 days, Priority Health batches a payment for the full allowed amount of each practice's billed G-codes and CPT codes with no member copayment or deductible.

    These payments are processed "offline" with a paper check.

    The check payment and Remittance Advice report are mailed to the provider's claims remittance advice address.

    A Remittance Advice report designates claim detail such as member demographics, billed codes and date of service.

Care management code Claims processing method
Code  Description Medicare Medicaid Commercial (fully funded plans)
G9001 Coordinated care fee, initial assessment Claims Claims Offline
G9002 Coordinated care fee, individual
face-to-face visit
 Claims Claims Offline
G9007 Coordinated care fee, scheduled
team conference
 Claims Claims Offline
G9008 Coordinated care fee, physician oversight service
 Claims Claims Offline
98966 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian 5-10 minutes of medical discussion
 Offline Offline Offline
98967 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian 11-20 minutes of medical discussion
 Offline Offline Offline
98968 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian 21-30 minutes of medical discussion
 Offline Offline Offline