cpt code exclusions checklist

CPT Code Exclusions Checklist

Before billing CPT Code 99490, consult Medicare guidelines:•Are you currently billing CPT code 99495 and/or 99496 for transitional care services?•Are you currently billing any CPT codes ranging from 90951-90970, for End-Stage Renal Disease services?•Are you using bundled reimbursements for CPT codes 99090-99091 for digital data services?

If you answer “YES” to any of the above, you cannot bill for 99490 for the same period.

Disclaimer: this is not a full, complete list and is not intended as legal advice.Code Coverage/Description CPT Category* Reimbursable? Billable alongside CPT 99490?

90951 – 90970 End Stage Renal Disease services Medicine Yes No99090 – 99091 Collection, interpretation, and analysis

of digitally stored clinical and physiological data

Medicine Yes, if bundled No

99381 – 99429 Preventive office visits and counseling services

E/M Yes Yes

Modifier 25 Marries preventive visits and resulting E/M services rendered

E/M Yes Yes

99441 – 99444 Non-face-to-face services E/M No N/A99487 – 99489 Complex chronic care coordination

servicesE/M No N/A

99490 Non-face-to-face complex chronic care services

E/M Yes Yes

99495 – 99496 Transitional care E/M Yes NoG0181 – G0182

Home health care and hospice care supervision

N/A (HCPCS Care plan oversight)

Yes No

*CPT section on Medicine codes correspond to physician tests and treatments, while E/M (Evaluation and Management) codes apply to patient visits/interactions