Care Plan Oversight Services

Under the provisions of the Balanced Budget Act of 1997, a Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS), practicing within the scope of state law, may bill for care plan oversight (CPO). These non-physician practitioners (NPPs) must be providing ongoing care for the beneficiary through evaluation and management services (but not if they are involved only in the delivery of the Medicare-covered home health or hospice service). Providers billing for CPO must submit the claim with no other services billed on that claim and may bill only after the end of the month in which the CPO services were rendered. CPO services may not be billed across calendar months and should be submitted (and paid) only for one unit of service. Physicians may bill and be paid separately only if all the criteria in the Medicare Claims Processing Manual, Chapter 12, are met.