T1016 Case management
Also known as: case management, care coordination, care manager
Case management services including assessment, planning, coordination, and monitoring of healthcare services for complex patient needs.
In Plain Language
care coordination; health management help
Clinical Context
Professional services coordinating and monitoring healthcare, social services, and support resources for patients with complex medical and social needs.
RVU Information
CPT T1016 does not have a physician work RVU assigned by CMS. Reimbursement for this code is determined by payer-specific fee schedules.
Billing & Documentation
This HCPCS code requires documentation of medical necessity and a valid physician order. Coverage and reimbursement policies vary by payer. Check with the specific insurer for prior authorization requirements.
Specialties
Frequently Asked Questions
What is CPT code T1016?
CPT T1016 (Case management) is a Other HCPCS code. Case management services including assessment, planning, coordination, and monitoring of healthcare services for complex patient needs.
Does Medicare cover T1016?
Medicare coverage for T1016 depends on medical necessity and applicable Local Coverage Determinations (LCDs). Professional services coordinating and monitoring healthcare, social services, and support resources for patients with complex medical and social needs. A physician order is typically required.
When is CPT T1016 used?
Professional services coordinating and monitoring healthcare, social services, and support resources for patients with complex medical and social needs.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.