Standard co-management service involving a documented clinical review shared between two treating providers

This HCPCS code represents a standardized payment for co-management services involving documented clinical review between a referring provider and a specialist or co-managing clinician. It captures the coordination and review component of shared patient management, distinct from a face-to-face evaluation and management service. The code reflects a defined, structured review process rather than an incidental communication between providers.

This code applies when a qualified clinician performs a documented review of clinical information as part of a formal co-management arrangement, such as between an ophthalmologist and an optometrist following cataract surgery or refractive procedures. Supporting documentation should include evidence of the co-management agreement, the specific clinical data reviewed, and the clinician's assessment or decision-making based on that review. It is most commonly associated with post-operative ophthalmic co-management scenarios under Medicare.

• Do not bill concurrently with a standard E/M service for the same date when the co-management review is the sole service rendered; payers may bundle or deny duplicate claims.
• Verify that a formal, written co-management agreement exists between the transferring and receiving providers prior to billing, as Medicare and many payers require this documentation to support the claim.
• Distinguish this code from global surgical package components — when a surgeon transfers post-operative care, the co-managing provider assumes responsibility for a defined portion of the global period, and modifier use (e.g., modifier 54/55) on the surgical code by the operating surgeon must align with this billing.