What is changing
We do not reimburse a charge for CPT code 99484 if provided in the same calendar month as CPT code 99492, 99493 or 99494.
We do not reimburse a charge for CPT codes 99492, 99493 or 99494 if provided in the same calendar month as CPT code 99484.
The codes above have the following abbreviated definitions:
- 99484 – Care management services for behavioral health conditions
- 99492 – Initial psychiatric collaborative care management
- 99493 – Subsequent psychiatric collaborative care management
- 99494 – Initial or subsequent psychiatric collaborative care management
Why is Humana implementing this change
According to the AMA CPT manual, behavioral health integration care management and psychiatric collaborative care management may not be reported by the same professional in the same month.
Providers affected
- Physician/Health Care Providers
Plan type
- Commercial fully insured products
- Medicare Advantage HMO products
- Medicare Advantage PFFS products
- Medicare Advantage PPO products
- Medicaid – Kentucky
Disclaimer: Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements still apply. Modifiers should be used when appropriate to accurately represent the services rendered. Please note that this notification may not describe previously implemented rules that still apply; the intent is to give notice of an upcoming change.
If requested by the self-funded group, all code-editing rules posted on Humana.com/edits for fully insured commercial Humana members also may be applied to self-funded members.