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36.11, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [6497, 6498]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 36.38, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 32.89, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [6499, 5781, 6500, 2118, 5969]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 28.75, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 31.79, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [6499, 5781, 6500, 2118, 5969]}]},{"negotiation_arrangement": "ffs", "name": "Hospice or Home Skilled Nursing Services", "billing_code": "G0299", "billing_code_type": "CPT", "billing_code_type_version": "2026", "description": "Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 116.0, "expiration_date": "2026-12-31", "billing_class": "institutional", "setting": "outpatient"}], "provider_references": [319, 320]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 150.0, "expiration_date": "2026-12-31", "billing_class": "institutional", "setting": "outpatient"}], "provider_references": [919, 921, 920, 922, 923, 924]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 60.0, "expiration_date": "2026-12-31", "billing_class": "institutional", "setting": "outpatient"}], "provider_references": [644]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 110.0, "expiration_date": "2026-12-31", "billing_class": "institutional", "setting": "outpatient"}], "provider_references": [926]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 120.0, "expiration_date": "2026-12-31", "billing_class": "institutional", "setting": "outpatient"}], "provider_references": [929]}]},{"negotiation_arrangement": "ffs", "name": "Blood Testing (Blood Count)", "billing_code": "G0306", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 10.41, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [260, 4984, 4985, 4892, 4986, 4987, 264, 4988]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 10.49, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [4989, 2497, 283, 2379, 2470, 4990, 3907, 2473, 351, 2444, 364, 288, 952, 352, 1093, 291, 489, 4991, 354, 297, 3831, 491, 4992, 409, 301, 4997, 330, 1475, 1258, 2425, 2397, 361, 4993, 2492, 312, 4994, 363, 4995, 4996, 499, 336]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 9.17, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [4989, 2497, 283, 2379, 2470, 4990, 3907, 2473, 351, 2444, 364, 352, 952, 288, 1093, 291, 489, 4991, 354, 491, 297, 3831, 336, 4992, 409, 301, 330, 1475, 1258, 2425, 2397, 361, 4993, 2492, 312, 4994, 363, 4995, 4996, 499, 4997]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 6.22, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [58]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 6.6, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [367]}]},{"negotiation_arrangement": "ffs", "name": "Blood Testing (Blood Count)", "billing_code": "G0307", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 8.67, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [260, 4985, 4984, 4892, 4986, 4987, 264, 4988]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 8.73, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [4989, 283, 2379, 2470, 4990, 3907, 2473, 351, 2444, 364, 288, 952, 352, 1093, 291, 489, 4991, 354, 3831, 491, 297, 336, 4992, 409, 301, 4997, 330, 1475, 1258, 2425, 2397, 4993, 361, 2492, 312, 4994, 363, 4995, 4996, 499, 2497]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 7.63, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [4989, 2497, 283, 2379, 2470, 4990, 3907, 2473, 351, 2444, 352, 288, 952, 1093, 489, 291, 4991, 354, 3831, 491, 297, 4992, 409, 301, 4997, 330, 1475, 1258, 2425, 2397, 4993, 361, 2492, 312, 4994, 4996, 363, 4995, 364, 499, 336]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 5.18, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [58]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 5.5, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [367]}]},{"negotiation_arrangement": "ffs", "name": "Hospital Inpatient or Observation Services", "billing_code": "G0316", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 41.36, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [6224, 6225, 6226, 6227, 2728, 6228, 6229, 6230, 264]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 39.93, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 41.67, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [6231, 132, 133, 1245, 3283, 5789, 1046, 1100, 2391, 5532, 2393, 5513, 6232, 6233, 6234, 6235, 6236, 2397, 5535, 1829, 2400, 2402, 1790, 5377, 6237, 2406, 135, 6238, 6239, 5512, 2014, 141, 1035, 1040, 2408, 2410, 2733, 5754, 2412, 190, 468, 147, 1099, 354, 5431, 2419, 2769, 3967, 6240, 2423, 1060, 2893, 2425, 1418, 2427, 6241, 1114, 1112, 6242, 5537, 2431, 2430, 6243, 2433, 6216, 3578, 1052, 336, 2437, 2439, 1452, 1176, 5891, 2531, 1036, 6217, 3326, 1488, 2446, 952, 5226, 1507, 2447, 1094, 1141, 1244, 6244, 1317, 192, 4542, 6245, 3222, 4543, 1250, 6246, 2451, 3060, 6153, 6247, 5503, 2454, 1135, 6156, 1148, 1149, 5953, 4760, 1394, 1445, 1153, 2892, 2345, 2721, 3061, 6132, 325, 2468, 2469, 2470, 2082, 2471, 2474, 6248, 2477, 6250, 1073, 6249, 4357, 4765, 2480, 2481, 5530, 5954, 2483, 3159, 4065, 5767, 1101, 2485, 5768, 3056, 2659, 5956, 2486, 2488, 5534, 5516, 2489, 6251, 3162, 2739, 2494, 1789, 2495, 1077, 2496, 2874]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 36.42, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 34.9, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [6231, 132, 133, 1245, 3283, 5789, 1046, 1100, 2391, 5532, 2393, 5513, 6232, 6233, 6234, 6235, 6236, 2397, 5535, 1829, 2400, 1790, 2402, 5377, 6237, 2406, 135, 6238, 6239, 1035, 2014, 141, 5512, 1040, 2408, 2410, 2733, 468, 5754, 190, 2412, 147, 1099, 354, 5431, 2419, 2769, 3967, 6240, 2423, 1060, 2893, 2425, 1418, 2427, 6241, 1112, 1114, 6242, 2431, 6243, 5537, 2430, 2433, 6216, 3578, 1052, 336, 2439, 2437, 1452, 1176, 5891, 2531, 1036, 6217, 3326, 1488, 1507, 2446, 5226, 952, 2447, 1094, 1141, 1244, 6244, 1317, 192, 4542, 6245, 3222, 4543, 6246, 1250, 2451, 3060, 6153, 6247, 5503, 2454, 1135, 6156, 1148, 1149, 5953, 4760, 1394, 1445, 1153, 2721, 2345, 325, 3061, 2892, 6132, 2468, 2469, 2470, 2082, 2471, 2474, 6248, 2477, 6250, 1073, 6249, 4357, 4765, 2480, 2481, 5530, 5954, 2483, 5767, 3159, 4065, 1101, 2485, 5768, 3056, 2659, 5956, 2486, 2488, 5534, 5516, 2489, 6251, 3162, 2739, 2494, 1789, 2495, 1077, 2496, 2874]}]},{"negotiation_arrangement": "ffs", "name": "Skilled Nursing Facility Services", "billing_code": "G0317", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 40.93, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [5881, 5882, 5883, 260, 264]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 41.23, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 39.49, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [5884, 4905, 3377, 5885, 296, 1790, 2445]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 36.04, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 34.52, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [5884, 4905, 3377, 5885, 296, 1790, 2445]}]},{"negotiation_arrangement": "ffs", "name": "Physician Home Visit", "billing_code": "G0318", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 40.5, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [6289, 6290, 6291]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 39.06, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 40.8, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [6292, 6293]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 35.66, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 34.14, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [6292, 6293]}]},{"negotiation_arrangement": "ffs", "name": "Behavioral Health Care Management", "billing_code": "G0323", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 55.64, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", 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to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++  ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++  ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired 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"negotiated_rate": 18.02, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 14.21, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [940, 3827, 4676, 5908, 5909, 5910, 2378, 2082, 2470, 5891, 3326, 1455, 4938, 2408, 2409, 2445, 145, 288, 5911, 5912, 489, 5343, 655, 294, 5913, 5914, 5915, 4065, 5789, 5916, 491, 857, 4936, 2390, 494, 301, 154, 1468, 4686, 4982, 5917, 5918, 3967, 5919, 2457, 5920, 2458, 2394, 2397, 5921, 4548, 2494, 5922]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 13.31, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 8.74, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 8.97, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 12.56, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [58]}]},{"negotiation_arrangement": "ffs", "name": "Care Coordination and Case Management", "billing_code": "G0557", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++  inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++  document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++  systematic needs assessment (medical and psychosocial). ++  system-based approaches to ensure receipt of preventive services. ++  medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++  care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++  ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++  ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++  ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 65.58, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 48.72, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [5902, 5903, 5904, 5905, 5906, 5907]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 49.09, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 66.07, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [940, 3827, 4676, 5908, 5909, 5910, 5891, 2378, 2082, 2470, 3326, 1455, 4938, 2445, 145, 2408, 288, 2409, 5911, 5912, 489, 5343, 655, 5913, 294, 5914, 5915, 4065, 5789, 491, 5916, 857, 4936, 2390, 494, 301, 154, 1468, 4686, 4982, 5917, 3967, 5918, 5919, 2457, 2394, 5920, 2458, 2397, 5921, 4548, 2494, 5922]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 57.75, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 42.9, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [940, 3827, 4676, 5908, 5909, 2378, 2082, 5910, 5891, 2470, 3326, 1455, 4938, 288, 2408, 2409, 2445, 145, 5911, 5912, 5343, 489, 655, 5913, 294, 5914, 5915, 4065, 5916, 857, 5789, 491, 4936, 2390, 494, 301, 154, 1468, 4686, 4982, 3967, 5918, 5917, 2457, 5919, 5920, 2394, 2458, 2397, 5921, 4548, 2494, 5922]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 26.7, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 27.4, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 41.0, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 43.69, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [58]}]},{"negotiation_arrangement": "ffs", "name": "Care Coordination and Case Management", "billing_code": "G0558", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Advanced primary care management services for a patient that is a qualified medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++  inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++  document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++  systematic needs assessment (medical and psychosocial). ++  system-based approaches to ensure receipt of preventive services. ++  medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++  care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++  ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++  ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 143.94, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 107.64, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [5902, 5903, 5904, 5905, 5906, 5907]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 145.02, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 108.45, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [940, 3827, 4676, 5908, 5909, 2378, 2470, 2082, 5910, 5891, 3326, 1455, 4938, 2445, 2409, 288, 2408, 145, 5911, 5912, 5343, 489, 655, 5913, 294, 5914, 5915, 4065, 857, 5916, 491, 5789, 4936, 2390, 494, 301, 154, 1468, 4686, 4982, 5917, 5918, 3967, 5919, 2457, 5920, 2394, 2458, 2397, 5921, 4548, 2494, 5922]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 94.79, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 126.76, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}], "provider_references": [940, 3827, 4676, 5908, 5909, 5910, 5891, 2470, 2378, 2082, 3326, 1455, 4938, 2409, 288, 145, 2445, 2408, 5911, 5912, 5343, 489, 655, 5913, 294, 5914, 5915, 4065, 5916, 491, 857, 5789, 4936, 2390, 494, 301, 154, 1468, 4686, 4982, 3967, 5918, 5917, 5919, 2457, 2394, 2458, 5920, 2397, 5921, 4548, 2494, 5922]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 89.44, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 95.3, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["02", "19", "21", "22", "23", "24", "25", "31", "34", "41", "42", "51", "52", "53", "56", "61"]}, {"negotiated_type": "negotiated", "negotiated_rate": 57.74, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}, {"negotiated_type": "negotiated", "negotiated_rate": 59.2, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["01", "03", "04", "05", "06", "07", "08", "09", "11", "12", "13", "14", "15", "16", "17", "18", "20", "26", "32", "33", "49", "50", "54", "55", "57", "58", "60", "62", "65", "71", "72", "81", "99"]}], "provider_references": [58]}]},{"negotiation_arrangement": "ffs", "name": "Postoperative Follow-Up Visit", "billing_code": "G0559", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "description": "Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable:    reading available surgical note to understand the relative success of the procedure, the anatomy that was affected, and potential complications that could have arisen due to the unique circumstances of the patient's operation.    research the procedure to determine expected post-operative course and potential complications (in the case of doing a post-op for a procedure outside the specialty).    evaluate and physically examine the patient to determine whether the post-operative course is progressing appropriately.    communicate with the practitioner who performed the procedure if any questions or concerns arise. (list separately in addition to office/outpatient evaluation and management visit, new or established)", "negotiated_rates": [{"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 11.86, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [6390, 6583, 6584, 6585]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 11.95, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", "service_code": ["CSTM-00"]}], "provider_references": [3638, 1187, 1176, 1033, 390, 1241, 1207, 6586, 949, 2307, 1092, 1317, 1099, 2001, 1465, 1100, 6587, 1436, 1101, 6588, 388, 6589, 1131, 1438, 1466, 1796, 1545, 1054, 1135, 4099, 1061, 1065, 1580, 3165, 6590, 1481, 1077]}, {"negotiated_prices": [{"negotiated_type": "negotiated", "negotiated_rate": 10.44, "expiration_date": "2028-01-01", "billing_class": "professional", "setting": "both", 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