2025 CPT code 0555F
(Active) Effective Date: N/A Revision Date: N/A Patient Management - Patient Management Category II Codes Feed
Documentation of a symptom management care plan (HF).
Modifiers may be appended as clinically indicated, to reflect the circumstances of performance measurement.
Medical necessity for code 0555F is established when a patient presents with symptoms that require a structured plan of care for management. This includes situations where symptoms significantly impact the patient's quality of life or functional status. The plan should be tailored to the individual patient's needs and should be based on evidence-based guidelines.
The clinical responsibility lies with the physician or qualified healthcare professional who develops and documents the symptom management plan. This includes assessing the patient's symptoms, determining appropriate interventions, and documenting the plan in the medical record.
In simple words: This code shows that a doctor has created a written plan to help manage your symptoms.The plan describes how to control your symptoms using medicine, lifestyle changes, or other methods.
This CPT Category II code, 0555F, represents the documentation of a structured symptom management plan of care for a patient.The code signifies that a comprehensive plan addressing the patient's symptoms has been created and documented in the medical record.It does not represent the actual provision of the care itself, but rather the creation and recording of the plan. The plan should detail strategies for symptom control, including medication management, lifestyle modifications, and other interventions as appropriate.This code is utilized for performance measurement and quality improvement purposes and does not carry a relative value unit (RVU).
Example 1: A patient with chronic heart failure (HF) presents with worsening dyspnea and edema. The physician develops a detailed symptom management plan outlining medication adjustments, dietary restrictions, fluid management strategies, and referral to cardiac rehabilitation., A patient with advanced cancer experiences severe pain and nausea. The oncologist creates a comprehensive symptom management plan addressing pain control with analgesics, antiemetics for nausea, and supportive measures to improve the patient's quality of life., A patient with multiple sclerosis (MS) experiences debilitating fatigue and spasticity. The neurologist develops a symptom management plan that includes medication adjustments, physical therapy, occupational therapy, and strategies for fatigue management.
* Detailed assessment of the patient's symptoms.* Specific interventions outlined in the symptom management plan.* Justification for the chosen interventions.* Documentation of the plan's implementation and its effectiveness in managing the patient's symptoms.* Progress notes reflecting adherence to the plan and adjustments made as needed.
** This code is optional and should not replace the use of Category I CPT codes for the actual services provided.
- RVU: 0
- Payment Status: Active
- Fee Schedule : This code does not have a fee schedule as it is a Category II code used for performance measurement and data collection. No payment is associated with this code.
- Specialties:Cardiology, Oncology, Neurology, Palliative Care, and other specialties where symptom management is a significant aspect of patient care.
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Skilled Nursing Facility, other settings where patient care is provided.