2025 CPT code 99375
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Care Plan Oversight Services Evaluation and Management Feed
Supervision of a home health patient (not physically present) requiring complex, multidisciplinary care; 30+ minutes of physician time per month.
Modifiers may apply depending on the specific circumstances of service. Consult the CPT manual and NCCI edits for guidance.
Medical necessity is established by the patient's complex medical condition requiring ongoing, multifaceted supervision and coordination of care from multiple healthcare providers, beyond the capabilities of the home health agency alone.Documentation should clearly support this need.
The physician is responsible for overseeing the patient's care plan, coordinating care with other healthcare professionals, reviewing reports and test results, and communicating with the patient's family and caregivers.
In simple words: This code covers a doctor's work overseeing a home healthcare patient's care plan.The doctor doesn't see the patient directly but works with the home health team, family, and others to coordinate the patient's care and make sure the plan is up-to-date. This takes at least 30 minutes per month.
This CPT code reports physician supervision of a patient under the care of a home health agency.The patient is not physically present during the supervision.The service involves complex, multidisciplinary care, including regular development/revision of care plans, review of patient status reports and test results, and communication with healthcare professionals, family, and caregivers.The physician must spend 30 minutes or more on these activities per calendar month.
Example 1: A 78-year-old patient with multiple chronic conditions (diabetes, heart failure, dementia) is receiving home healthcare. The physician reviews reports from the home health aide, consults with the patient's family, and adjusts the medication regimen based on the patient's progress., A 65-year-old patient recovering from a stroke requires complex physical and occupational therapy. The physician coordinates care with the therapists, reviews progress reports, and modifies the therapy plan based on the patient's response., A 50-year-old patient with advanced cancer is receiving palliative care at home. The physician regularly communicates with the hospice team, family, and caregivers, adjusting the pain management plan and other aspects of care as needed.
Detailed documentation of time spent, specific activities undertaken (e.g., phone calls, reviewing reports, care plan adjustments), communication with other healthcare providers, and rationale for care plan modifications.
** Only one provider may bill this code for a given patient within a 30-day period.This code should not be used for supervision of patients in nursing facilities or under home health agencies unless recurrent supervision of therapy is required.The work of very low intensity supervision is included in the pre- and post-encounter work for other home, office, or nursing facility visit codes.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- RVU: This information is not readily available from the provided sources.RVUs vary based on geographic location and other factors.Consult your local Medicare Administrative Contractor (MAC) for the most accurate information.
- Global Days: Not applicable. This is not a global procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This code does not have a technical component.
- Fee Schedule: Historical fee schedule information is not available in the provided sources.Consult fee schedules from previous years for historical data. Remember that payment varies by location and payer.
- Specialties:Geriatrics, Oncology, Neurology, Cardiology, and other specialties involved in the care of patients with complex, multidisciplinary needs.
- Place of Service:Office, Home, Assisted Living Facility, Skilled Nursing Facility, other facilities providing long-term care, or telehealth in certain instances.