ModMed APCM Billing Code Setup Checklist

Ensure G0511 or specific APCM codes are added to the ModMed master fee schedule for all relevant payers.

Configure modifiers like -25 or -59 specifically for chronic care visits within the billing module settings.

Define billing rules for Medicare and commercial payers within the ModMed Practice Management settings to avoid rejections.

Enable alerts in ModMed to prevent APCM billing during post-op periods for orthopedic or surgical procedures.

Link the completion of a Chronic Care note in EMA to the automatic generation of a billing claim in the ledger.

Add specific APCM documentation layers to your dermatology or GI templates to capture time spent and clinical goals.

Utilize the ModMed Care Plan section to document the required 20 minutes of non-face-to-face care per month.

Create smart phrases or macros in EMA to quickly document care coordination time for APCM compliance audits.

Use the Communications tab to document interactions with primary care providers for shared patients with chronic issues.

Run a weekly report in ModMed to ensure all APCM-billed encounters have a signed and updated care plan on file.

Integrate your AI call center with the ModMed API to automatically log patient check-ins and triage outcomes.

Use AI voice agents to call eligible chronic patients and explain the benefits of the APCM program for their condition.

Ensure AI-handled triage calls are tracked as billable time within the ModMed chronic care management dashboard.

Configure the AI system to trigger follow-up calls based on ModMed clinical task statuses or medication changes.

Implement an automated phone workflow to capture and record verbal patient consent for APCM billing as required by CMS.

Filter your patient database by ICD-10 codes related to specialty chronic conditions like psoriasis or Crohn's disease.

Use ModMed Patient Flags to identify individuals who meet CMS criteria for two or more chronic disease states.

Verify Medicare Part B status through the ModMed real-time eligibility tool before enrolling patients in APCM.

Utilize the ModMed reporting engine to track cumulative staff and AI time spent per patient per calendar month.

Generate reports to find chronic patients who haven't had a billable interaction in the last 30 days for proactive outreach.