G2065 HCPCS - COMPREHENSIVE CARE MANAGEMENT FOR A SINGLE HIGH-RISK DISEASE SERVICES, E.G. PRINCIPAL CARE MANAGEMENT, AT LEAST 30 MINUTES OF CLINICAL STAFF TIME DIRECTED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, PER CALENDAR MONTH WITH THE FOLLOWING ELEMENTS: ONE COMPLEX CHRONIC CONDITION LASTING AT LEAST 3 MONTHS, WHICH IS THE FOCUS OF THE CARE PLAN, THE CONDITION IS OF SUFFICIENT SEVERITY TO PLACE PATIENT AT RISK OF HOSPITALIZATION OR HAVE BEEN CAUSE OF A RECENT HOSPITALIZATION, THE CONDITION REQUIRES DEVELOPMENT OR REVISION OF DISEASE-SPECIFIC CARE PLAN, THE CONDITION REQUIRES FREQUENT ADJUSTMENTS IN THE MEDICATION REGIMEN, AND/OR THE MANAGEMENT OF THE CONDITION IS UNUSUALLY COMPLEX DUE TO COMORBIDITIES

Code Information

HCPCS Code: G2065
Sequence Number: 0010
Short Description: Clin mang h risk dx 30
Long Description: Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
Date Added: 1/1/2020
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2022
Classification: Temporary Procedures & Professional Services
Coding System: HCPCS

Code Type

Berenson-Eggers Type Of Service Code: M5D - Specialist - other
Type Of Service Code:
- 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96

Billing Information

Pricing Indicator Code:
- 13 - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: C - Carrier judgment

HCPCS Record

Field Name	Field Value
Healthcare Common Procedure Coding System Code	G2065
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
HCPCS Short Description	Clin mang h risk dx 30
HCPCS Pricing Indicator Code 1	13 - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Code	C - Carrier judgment
HCPCS Berenson-Eggers Type Of Service Code	M5D - Specialist - other
HCPCS Type Of Service Code 1	1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2020
HCPCS Action Effective Date	1/1/2022
HCPCS Termination Date	12/31/2021
HCPCS Action Code	N - No maintenance for this code

Code Information

Code Type

Billing Information

HCPCS Record

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