Spreadsheet: 737401d1624395207-help-with-index-and-match-functions-that-act-dynamically-example
Sheet: Care Gap Appendix

Care Gap or Incentive | Code Category Type* | Code(s) Included | Estimated Low Revenue per visit | Estimated Midpoint Revenue per visit | Estimated High Revenue per visit
Just E&M Visits | E&M Only (Ranges of Codes based on the type of Visit documented) | 99201-99205, 99211-99215, 99341-99350, 99381-99412, 99429, 99455,99456,99483,  99497, 99498 G0402,G0438,G0439,G0463 | 54.43 | 168.53 | 282.63
[NAME] assessment | E&M Plus Informational Code | E&M Only list, plus 3008F | 0 | 0 | 0
Advanced care planning | Care Only | 99497, and 99498 (each additional 30 mins) | 74.32 | 80.08 | 85.84
Annual monitoring for patients on ACE or ARB | E&M Plus Care | E&M Only list, plus 80047, 80048, 80050, 80053, 80069, 80051, 84132, 82565, 82575 | 4.76 |  | 13.73
Antidepressant medication management - acute | E&M Plus Prescription | E&M Only list plus specific medications, at least 64 days and at least 180 days | 0 | 0 | 0
Antidepressant medication management - chronic | E&M Plus Prescription | E&M Only Listplus specific medications, at least 64 days and at least 180 days | 0 | 0 | 0
Asthma medication ratio - total | E&M Plus Prescription | E&M plus specific [NAME] Code(s) | 0 | 0 | 0
Breast Cancer Screening | E&M plus Care | E&M Only List and/or 77055-77057, 77061-77063, 77065-77067, or G0202, G0204, G0206 | 47.8 | 106.95 | 166.09
Care for older adults: functional status assessment | Care Only plus Informational Zero Dollar Charge | 99497 and 99498 (for 30 addl minutes) plus 1170F | 0 | 0 | 0
Care for older adults: medication review | Care Only plus Informational Zero Dollar Charge | 99497 and 99498 (for 30 addl minutes) plus 1159F and 1160F (Both are needed for assessment) | 0 | 0 | 0
Care for older adults: pain assessment | Care Only plus Informational Zero Dollar Charge | 99497 and 99498 (for 30 addl minutes) plus 1125F or 1126F | 0 | 0 | 0
Cervical cancer screening | E&M Plus Care | E&M Only list [NAME], G0123,G0124,G0141,G0143,G0144,G0145,G0147,G0148,P3000,P3001, Q0091, 87620,87621,87622,87624,87625 | 14.65 | 32.61 | 50.56
Chlamydia screening | E&M Plus Care | E&M Only List and 87110, 87270,87320, 87490, 87491, 87492 or 87810 | 11.98 | 32.73 | 53.47
Colorectal Cancer Screening | Care Only (Just Diagnostic Colonoscopy Included) | 45378 plus G0105 or G0121 | 178.3 | 267.81 | 357.31
Comprehensive diabetes  care: HbA1c testing | E&M Plus Care | E&M Only List and 83036, 83037, 3044F-3046F, or 3051F, 3052F | 9.71 | 9.71 | 9.71
Comprehensive diabetes care: diabetes control (HbA1c <8%) | E&M Plus Care | E&M Only List and 83036, 83037, 3044F-3046F, or 3051F, 3052F | 9.71 | 9.71 | 9.71
Comprehensive diabetes care: eye exam | Care Only (Needs to be an Optomistrist or Ophthamologist only) | 92002-92014,(92225, 92226,92201,92202 for Medicare Advantage Members), 3072F, 2022F, 2024F, 2026F | 87.58 | 120.03 | 152.48
Comprehensive diabetes care: medical attention for neuropathy | E&M Plus Care | E&M Only List and 82042, 82043, 82044, 84156, 3060F or 3061F | 3.67 | 5.73 | 7.78
Comprehensive diabetes care: blood pressure control | E&M with Informational Zero Dollar Charge | E&M Only List and 3077F, 3074F, 3075F, 3079F, 3078F, 3080F, plus all dates and bp readings to close gap | 0 | 0 | 0
Controlling High Blood Pressure | E&M with Informational Zero Dollar Charge | E&M Only List and 3077F, 3074F, 3075F, 3079F, 3078F, 3080F, plus all dates and bp readings to close gap | 0 | 0 | 0
Influenza vaccinations for adults ages 18-64 | E&M Plus Care | E&M Only List plus 90653, 90694, 90662, 90672, 90674, 90682, 90685, 90686, 90687, 90688, 90756 | 9.58 | 35.29 | 61
Influenza vaccinations for adults age 65 and older | E&M Plus Care | E&M Only List plus 90653, 90694, 90662, 90672, 90674, 90682, 90685, 90686, 90687, 90688, 90756 | 9.58 | 35.29 | 61
Pneumonia vaccination status in older adults | E&M Plus Care | 90670, 90669, 90732 or 4040F | 119.92 | 175.03 | 230.14
Preventative care and screening: screening for depression and follow-up plan | E&M Plus Care | E&M Only List plus G8431 or G8510 or 96127 plus Screening Tool results to close gap | 4.89 | 4.89 | 4.89
Use of spirometry testing in the assessment and diagnosis of COPD | E&M Plus Care | E&M Only List plus 94010,94011,94012,94060,94070,94150,94200,94375,94726, 94727 and COPD Dx Code | 18.14 | 40.65 | 63.16
Well-child visits (specify age range) | Well Child Visits | 99381-99385, or 99391-99395 only for kids 0-18 | 78.43 | 92.45 | 106.47
Incentive for Each Patient Achieving Diabetes Control for United Healthcare Medicare Advantage | E&M Plus Care | E&M Only List and 83036, 83037, 3044F-3046F, or 3051F, 3052F | 9.71 | 9.71 | 9.71
Incentive for Each Patient Receiving Annual Wellness Visit Completed for United Healthcare Medicare Advantage | E&M Only | G0438 or G0439 | 133.64 |  | 169.23
Incentive for Each Patient Receiving Breast Cancer Screening for United Healthcare Medicare Advantage | E&M Plus Care | E&M Only List and/or 77055-77057, 77061-77063, 77065-77067, or G0202, G0204, G0206 | 47.8 | 106.95 | 166.09
Incentive for Each Patient [NAME] use in People with Diabetes for United Healthcare Medicare Advantage | E&M Plus Prescription | E&M plus Statin medication prescription | 0 | 0 | 0
Incentive if 75% of Providence MA Patients Receive Annual Wellness Visit and 75% of Chronic Conditions are Recaptured | Care Only | G0438 or G0439 | 133.64 |  | 169.23
Medicare Annual Wellness Visit | Care Only | G0438 or G0439 | 133.64 |  | 169.23
Statin use in People with Diabetes | E&M Plus Prescription | E&M plus Statin medication prescription | 0 | 0 | 0
Transitions of care: Medication reconciliation post-discharge | Care Only | 99495 or 99496 | 207.96 | 244.77 | 281.59