The provision to a patient, patient's relative(s), patient's representative or other caregiver(s) of medical advice, direction or information by telephone, fax or e-mail in which a change in the frequency or dose of insulin therapy is initiated regarding a patient treated with insulin injections (2 or more daily) or insulin by pump (a "contact"). In addition to the common elements, the components of this service include the following specific elements. A. Monitoring the condition of a patient with respect to insulin therapy, including ordering blood tests, reviewing patient's glucose self-monitoring, interpreting the results and inquiry into possible complications. B. Adjusting the type, frequency and dose of insulin therapy, and where appropriate, prescribing alternate or additional therapy. C. Discussion with, and providing advice and information to the patient, patient's relative(s), patient's representative or other caregiver(s), by telephone, fax or e-mail on matters related to the service, regardless of identity of person initiating discussion. D. Making arrangements for any related assessments, procedures and/or therapy and interpreting results as appropriate. E. Providing premises, equipment, supplies and personnel for the specific elements.
G500, G514 and G520 are only eligible for payment when rendered by the physician most responsible for the patient's diabetes care or by a physician substituting for that physician ("the substitute physician").
The clinical decision(s) pertaining to the medical advice, direction or information provided must be formulated personally by the physician or substitute physician.
A contact rendered on the same day as a consultation or assessment by the same physician to the same patient does not constitute a contact for the purpose of G500, G514 or G520.
G500, G514 and G520 are not eligible for payment for reviewing laboratory reports, patient created reports, or for communicating results to a patient when no change in the frequency or dose of insulin therapy is required.
Only one of G500, G514 and G520 is eligible for payment per patient per physician per month.
G500/G514/G520 is only eligible for payment when a dated summary of each contact is recorded in the patient's permanent medical record.
1. The clinical decision(s) formulated by the physician or substitute physician may be communicated to the patient, patient's relative, patient's representative or other caregiver by a staff member other than the physician.
2. Month refers to a calendar month.
3. If G514 and G520 are claimed in the same month by the same physician for the same patient, the total fee eligible for payment will be adjusted to the value of G520.