Standard co-management service for documented clinical data review between referring provider and specialist

This HCPCS code represents a standard co-management service payment for the documented review of clinical data shared between a referring provider and a co-managing specialist, typically within the context of Medicare's Integrated Care programs or collaborative care models. It captures the professional work associated with reviewing patient information, care plans, or clinical findings without a face-to-face encounter occurring. This is a payment mechanism designed to support coordinated, team-based care arrangements where formal co-management agreements are in place.

This code applies when a qualified provider performs a documented review of clinical information as part of a structured co-management arrangement, such as those seen in ophthalmology/optometry surgical co-management or similar specialty-primary care collaborative models. Supporting documentation should include evidence of the co-management agreement, the specific clinical data reviewed, the date of review, and the reviewing provider's attestation. It is most commonly encountered in post-operative co-management scenarios where the operating surgeon transfers a portion of the global period care to another provider.

• Verify that a formal, signed co-management agreement exists between the providers prior to billing; absence of this documentation is a common audit trigger and claim denial reason.
• Do not confuse this with standard E/M visit codes — this code is specific to the review component of co-management and should not be billed alongside a separately reported office visit for the same service on the same date without clear documentation of distinct services.
• Payer policies vary significantly; confirm Medicare Administrative Contractor (MAC) guidelines and any applicable global surgery period rules, as billing during an active global period requires careful coordination to avoid duplicate payment issues.