In simple words: This code covers a doctor's work overseeing the care of a nursing home patient.The doctor doesn't see the patient directly but spends at least 30 minutes each month coordinating care with other healthcare providers and managing the patient's treatment plan.

This CPT code reports physician supervision of a nursing facility patient who is not physically present at the time of service.The patient requires complex, multidisciplinary care involving regular development and/or revision of care plans.The service includes reviewing patient status reports, laboratory and other studies, and communicating with healthcare professionals, family members, or caregivers. The physician integrates new information into the treatment plan and adjusts medical therapy as needed.The total time spent on these activities must be 30 minutes or more within a calendar month.

Example 1: A patient with multiple chronic conditions (e.g., diabetes, hypertension, heart failure) residing in a skilled nursing facility requires coordinated care from multiple specialists (e.g., cardiologist, endocrinologist, nephrologist). The physician overseeing the care reviews reports, consults with other specialists, and adjusts medications as needed, spending over 30 minutes on this task in a month., A patient recovering from a stroke in a rehabilitation facility requires physical therapy, occupational therapy, and speech therapy. The supervising physician reviews therapy progress notes, orders additional tests, communicates with therapists, and adjusts the patient's medication regimen based on the updates, exceeding 30 minutes of care plan oversight., A patient with complex wound care needs in a long-term care facility requires regular assessment and care plan adjustments. The overseeing physician reviews wound care progress notes, consults with wound care specialists, and orders appropriate treatments or medication adjustments, dedicating more than 30 minutes monthly to care plan oversight.

Detailed documentation should include the date and time of each contact, a description of the services provided, and the total time spent for the month.This should include notes of communications with other healthcare providers, family members, or caregivers; review of test results, reports and plans; modifications to the care plan; and adjustment of the medical therapy.All documentation should be directly linked to the specific patient and be easily auditable. Supporting documentation (e.g., progress notes, lab reports, consultation notes) should also be maintained.

** Only one provider may bill for care plan oversight services for a given patient within a 30-day period.The code should not be reported for supervision of patients in nursing facilities or under the care of home health agencies unless they require recurrent supervision of therapy.This service should be billed separately from office/outpatient, hospital, home, or other services.