Are case management services reimbursable by third-party payers?
Again, it depends on the payer. While a commercial payer may reimburse a claim for case management services, it is neither clear as to the code to submit nor what is considered fair and equitable reimbursement. Despite the N status designation given by CMS for codes 98966, 98967 and 98968, the AMA did assign a relative value for each code. This in turn does support some consistency in private payer reimbursement. Q: What alternatives are available to case managers regarding remuneration for their services? A: Case managers can and do seek payment directly from their clients on an hourly basis. Q: Will getting a CPT code resolve the situation of recognition of case management services and reimbursement? A: Not really. There are actually three key elements involved with reimbursement for services: coding, coverage and payment. Establishing dedicated codes is just the first step. The next is to have the code(s) deemed a covered service, assigned an accurate relative value weight, and give
