ID APCM Billing Setup Checklist | Infectious Disease Coding

Enter G0511 and specific APCM level codes into your EHR fee schedule with updated 2024 CMS rates.

Link Infection-Associated Chronic Condition codes (e.g., B20 for HIV, B18.1 for Hep B) to the APCM billing module.

Set system alerts for 20-minute and 60-minute thresholds for non-face-to-face clinical staff time.

Create ID-specific templates that include antiretroviral therapy (ART) monitoring and viral load review.

Ensure the system allows for same-day E/M visits alongside APCM enrollment without triggering automatic denials.

Confirm patient has at least two chronic conditions or one complex condition like HIV/AIDS per CMS guidance.

Document verbal or written consent for APCM services, explaining the cost-sharing and 24/7 access benefits.

Identify high-risk patients who require intensive monitoring for medication adherence or opportunistic infections.

Configure the AI call system to introduce APCM benefits to eligible HIV and Hepatitis B patient populations.

Assess barriers such as pharmacy access or transportation during the initial APCM enrollment session.

Precisely record time spent on ART counseling, lab coordination, and specialty pharmacy communication.

Ensure AI-handled patient check-ins and adherence reminders are automatically exported to the EHR patient note.

Update the comprehensive care plan at least quarterly for patients with evolving conditions like Long COVID.

Document how APCM services integrate with and do not duplicate Ryan White funded case management.

Verify that every APCM billing cycle includes a review of potential drug-drug interactions with antivirals.