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Forum Discussion Areas > Ask Us a Question > Assisted Living Facility Visits - Billing and Coding
  Assisted Living Facility Visits - Billing and Coding
kbarney
Assisted Living Facility Visits - Billing and Coding
Posted:
Jan 8 2010, 2:03 PM
Our physicians have never billed for the above, but it appears that the first of them has started. It would seem pretty straightforward to me, but I want to make sure that I have alll of my information correct. It would be billed using the 99324-99337 range of codes. Are these Medicare covered services? I would think that we will likely be seeing a lot more of these.

 
Codapedia Editor
Assisted living
Posted:
Jan 8 2010, 3:40 PM
These are covered services. The only tricky thing is that sometimes, there are independent, free standing apartments and also assisted living on the same campus. If the patient lives independently, then use home visits. If the patient has the assistance described below, these codes. And of course, the place of service has to match.

The Medicare manual section is from: http://www.cms.hhs.gov/Manuals/IOM/list.asp

Publication 100-04, Chapter 12, Section 30.6.14

30.6.14 - Home Care and Domiciliary Care Visits (Codes 99324- 99350) (Rev. 775, Issued: 12-02-05, Effective: 01-01-06, Implementation: 01-03-06) Physician Visits to Patients Residing in Various Places of Service The American Medical Association’s Current Procedural Terminology (CPT) 2006 new patient codes 99324 – 99328 and established patient codes 99334 - 99337(new codes beginning January 2006), for Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services, are used to report evaluation and management (E/M) services to residents residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis. These CPT codes are used to report E/M services in facilities assigned places of service (POS) codes 13 (Assisted Living Facility), 14 (Group Home), 33 (Custodial Care Facility) and 55 (Residential Substance Abuse Facility). Assisted living facilities may also be known as adult living facilities. Physicians and qualified nonphysician practitioners (NPPs) furnishing E/M services to residents in a living arrangement described by one of the POS listed above must use the level of service code in the CPT code range 99324 – 99337 to report the service they provide. The CPT codes 99321 – 99333 for Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services are deleted beginning January, 2006. Beginning in 2006, reasonable and medically necessary, face-to-face, prolonged services, represented by CPT codes 99354 – 99355, may be reported with the appropriate companion E/M codes when a physician or qualified NPP, provides a prolonged service involving direct (face-to-face) patient contact that is beyond the usual E/M visit service for a Domiciliary, Rest Home (e.g., Boarding Home) or Custodial Care Service. All the requirements for prolonged services at §30.6.15.1 must be met. The CPT codes 99341 through 99350, Home Services codes, are used to report E/M services furnished to a patient residing in his or her own private residence (e.g., private home, apartment, town home) and not residing in any type of congregate/shared facility living arrangement including assisted living facilities and group homes. The Home Services codes apply only to the specific 2-digit POS 12 (Home). Home Services codes may not be used for billing E/M services provided in settings other than in the private residence of an individual as described above.

 

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