2025 CPT code 99378
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Care Plan Oversight Services Evaluation and Management > Care Plan Oversight Services Feed
Supervision of a hospice patient (patient not present) requiring complex care, involving care plan development/revision, report review, communication with healthcare professionals, family, and caregivers; 30 minutes or more per calendar month.
Modifiers may apply depending on the circumstances of the service. Consult the CPT manual and payer guidelines for the appropriate modifier use.
Medical necessity is established by the patient's terminal illness requiring multidisciplinary care and the need for regular supervision and coordination of the care plan.Documentation should support the patient's terminal prognosis, the need for complex care from multiple specialties, the frequency and extent of the physician's involvement in care plan oversight, and the complexity of the care plan.
The physician's clinical responsibility includes indirect care of a hospice patient, requiring coordination of care with other specialists, review of patient status reports and tests, communication with healthcare professionals and family/caregivers, and adjustment of the treatment plan based on patient needs.
In simple words: This code is used when a doctor oversees the care of a terminally ill hospice patient without directly seeing them.The doctor works with other healthcare providers, the patient's family, and caregivers to create and update the patient's care plan, review test results, and make sure the patient gets the best possible care.The doctor spends at least 30 minutes doing this each month.
This CPT code reports physician supervision and coordination of care for a hospice patient not directly seen by the physician.It encompasses activities such as developing or revising care plans, reviewing patient status reports and lab results, communicating with healthcare professionals, family members, surrogate decision-makers, and key caregivers to assess the patient's condition and make care decisions, integrating new information into the treatment plan, and adjusting medical therapy.The physician must spend 30 minutes or more on these activities within a calendar month.Only one provider may bill for a given patient in a given period. This code should not be used for supervision of patients in nursing facilities or under the care of home health agencies unless recurrent therapy supervision is required.Low-intensity or infrequent supervision is included in other E&M codes.
Example 1: A patient with end-stage lung cancer receives hospice care at home. The oncologist manages the cancer treatment, but the primary care physician uses code 99378 to bill for care plan oversight, coordinating care with the oncologist, home health agency, and physical therapist; reviewing test results; communicating with the family; and adjusting the pain management plan as needed, spending over 30 minutes on these activities each month., A patient with metastatic breast cancer is in hospice care at a nursing facility.Their primary care physician coordinates care with the oncologist, pain management specialist, and nursing staff; reviews labs and other reports; communicates with family members regarding changes in the patient's condition; and adjusts the plan for pain management and comfort care.The physician spends over 30 minutes monthly on this, billing with 99378., A patient with advanced heart failure is under hospice care at home. The cardiologist manages their medications, but the primary care physician uses code 99378 for coordinating with other medical providers including the home health nurse and the family caregiver; reviewing patient progress reports; and making necessary adjustments to the care plan, requiring at least 30 minutes of indirect care per month.
Detailed documentation is required, including the total time spent on care plan oversight (at least 30 minutes per calendar month), specific activities undertaken (e.g., care plan development/revision, communication with other providers, family, and caregivers, review of reports and test results), dates of service, and medical necessity supporting the need for these services.
** Payers may have specific requirements or limitations for reimbursement of 99378.Always check payer-specific guidelines before submitting claims.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- Payment Status: Active (Medicare payment may vary based on specific circumstances and payer policies)
- Modifier TC rule: Not applicable.
- Specialties:Hospice and Palliative Medicine, Family Medicine, Internal Medicine, Oncology
- Place of Service:Home, Hospice Facility, Nursing Facility (although Medicare may not cover services rendered in a nursing facility)