Care Plan Oversight ServicesMarch 1st, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Care Plan oversight services are commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other healthcare professional within a 30-day period.
|G0179||MD re-certification HHA PT||May be submitted per certification period|
|G0180||MD certification HHA patient||May be submitted per certification period|
|G0181||Home health care supervision||Requires 30 minutes or more of physician or NPP's time within a calendar month|
|G0182||Hospice care supervision||Requires 30 minutes or more of physician or NPP's time|
NOTE: Medicare does not pay for care plan oversight services for nursing facility or skilled nursing facility patients.
CPO: Home Health
Medicare pays separately for the services involved in physician certification/re-certification and development of a plan of care for Medicare-covered home health services when certain criteria are met.
- Submit HCPCS code G0180 when the patient has not received Medicare-covered home health services for at least 60 days. The initial certification (HCPCS code G0180) cannot be submitted for the same date of service as the supervision service HCPCS code (G0181).
- Submit HCPCS code G0179 for re-certification after a patient has received services for at least 60 days (or one certification period).
- HCPCS code G0179 may be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapse and requires a new plan of care to start a new episode.
Special notes regarding certification and re-certification of home health care:
- Physicians play a key role in determining and documenting the medical necessity for home health care for Medicare beneficiaries. As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
- For more information about required documentation for home health certification and re-certification, please refer to the CGS web article "Face to Face Documentation for Home Health Certification: Important Information for Certifying Physicians and Non-physician Practitioners (NPPs)."
Submit HCPCS code G0182 for CPO services provided to patients that have elected hospice benefits under Medicare and who are in a Medicare-approved hospice.
For criteria for coverage, documentation, and billing requirements please review your carriers policy:
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 15, section 30, sub-section G
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 12, section 180
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
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