Standard co-management service for a specialist's documented review of shared clinical data without a face-to-face visit

This HCPCS code represents a standard co-management service payment for the documented review of clinical data shared between a primary managing provider and a co-managing specialist, typically within the context of Medicare's Integrated Care programs or collaborative care models. It captures the administrative and clinical coordination work performed when a specialist reviews patient information forwarded by the treating provider without a face-to-face encounter. The service reflects the cognitive and evaluative work involved in interpreting shared clinical findings and contributing recommendations to the patient's care plan.

This code applies when a co-managing clinician performs a documented review of clinical information — such as lab results, imaging, or care summaries — transmitted from the primary provider, and that review is part of a formal co-management arrangement. It is most commonly associated with CMS-defined co-management payment structures, such as those tied to Global Surgery co-management or specialty co-management agreements. Supporting documentation should include evidence of the co-management arrangement, the specific clinical data reviewed, and the clinician's assessment or recommendations resulting from that review.

• Verify that a formal, documented co-management agreement exists between the providers prior to billing; absence of this agreement is a common audit trigger.
• Do not confuse this with standard E/M consultation codes or care management codes (e.g., CCM, PCM) — this code is specific to the co-management payment structure and is not interchangeable with those services.
• Confirm payer acceptance before submitting; this code is primarily applicable to Medicare and may not be recognized by commercial payers, requiring alternative coding strategies for non-Medicare populations.