g0181 cpt code reimbursement

Date of service (DOS) for Care Plan Oversight services (CPO) – G0181

The CPO code, G0181 descriptor reads as follows: Physician Supervision of a patient under care of Medicare covered home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development, and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved with the patient’s care, integration of new information into the treatment plan and/or adjustments of medical therapy, within a calendar month; 30 minutes or more.

Hence this code is a monthly code, and may be billed on a monthly basis as long as CPO services are provided, and the patient is enrolled in a home health episode. You may bill for the first and second month. Once the home health care episode ends, then CPO services are no longer covered.

The date of service would be the date on which the Physician reviews the report and integrates any new information into the treatment plan and / or adjustments of medical therapy. Medical records for these services must indicate that the physician spent 30 minutes or more for countable care planning activities. For example if Home Health episodes starts of care beginning at July 1 and if the Physician spent 15 minutes on July 6 and another 15 minutes on July 25 for planning activities then the service would be reported with code G0181 with date of service July 6 to July 25 with only one unit of service. In the above example Physician may also submit claims with date of service as July 25, the date on which he completes a total of 30 minutes.

Do not submit code G0181 on the same day when the episode begins.

Do not submit the first and last calendar date of the month unless services were provided on those dates). Report care planning only once per calendar month.

Medicare does not pay for care plan oversight services for nursing facility or skilled nursing facility patients.

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