Medicaid to reimburse for group chronic disease management

Beginning March 1, the Texas Medicaid Program will reimburse physicians for group clinical visits according to a Jan. 9 bulletin posted on the Texas Medicaid Healthcare Partnership Web site. Group clinical visits may be used to manage chronic conditions such as diabetes and asthma for established patients. These visits must last at least one hour and have a minimum of two and maximum of 20 participants. It should include a presentation on clinical issues to promote the self-management of chronic disease; a question-and-answer period; and a brief one-on-one, private encounter with the physician that consists of a physical exam, review of any medical tests and the crafting of an individual treatment plan.

The exact rate for code 1-99078 will be established through a later rate hearing process. Read the bulletin for additional reimbursement for evaluation and management services, claim requirements and other information.

Performing group visits to enhance patient care is one of many recommended elements in the new model of care as described in the Future of Family Medicine report and implemented through the TransforMED project.