Care plan oversight can be billed with G0179 (recertification of a patient for home health care), G0180 (certification of a patient for home health care), G0181 (home health care supervision) and G0182 (hospice care supervision).
Descriptions and billing guidelines for the Care plan oversight CPT codes can be found below.
G0179 CPT Code Description & Billing Guidelines
G0179 can be billed for for recertification for medicare covered home health service by an allowed physician or practioner if the patient is not present and under a home health plan of care.
Contacts with the home health agency are included. Physician or allowed practitioner re-certification for Medicare-covered home health services under a home health plan of care (patient not present).
Reports of the status of the patient is required to affirm the initial implementation of the plan of care.
Report G0179 for recertification for home health services by a provider who reviews the patient’s medical records and determines the need for continued services. Make sure to follow billing guidelines below.
The provider reports G0179 for the recertification of a patient for home health services after a Medicare covered home health agency has cared for him for 60 or more days.
Home health services include multidisciplinary care methods such as:
- review of reports and laboratory studies;
- regular monitoring of development;
- revision of care plans; and
- communication with healthcare providers.
The patient is not present during the G0180 recertification process.
During recertification the provider;
- reviews data collected by the agency;
- reviews the patient’s plan of care; and
- verifies whether the home health agency has complied with the plan of care.
G0180 CPT Code Description And Biling Guidelines
G0180 can be billed for the certification of a patient for home health care. The patient can’t be present.
To affirm the implementation of care plan, reports of the patient status need to be reviewed. The contacts with home health agency are included.
Report G0180 for initial certification for need for home health services by a provider who reviews the patient’s medical records and determines the need for continued services.
Make sure to follow the billing guidelines for G0180 as defined below.
These certification services includes multidisciplinary care methods such as:
- review of reports;
- revisions of care plans (laboratory studies are included); and
- regular monitoring of progression with the plan.
The patient is not present during G0180 certification process.
G0180 can only be billed if the provider certifies a patient to at least 60 days of home health care services.
A patient receives G0180 certification has not received Medicare covered home health service for the minimum of 60 days.
The supervising provider oversees the care plan and must be personally furnished by this provider.
The provider who bills G0180 must remain actively involved in the patient’s care throughout the home health service period.
Document amount of time spent and the date in the record of the patient
G0181 CPT Code Description And Biling Guidelines
G0181 can be billed for home health care supervision. The allowed practitioner or physician provided the services provided by a participating home health agency. G0181 will be denied if the patient is present.
G0181 requires multidisciplinary and complex care modalities. Revision an/or development of care plans are required by the physician or practitioner.
Make sure to follow the billing guidelines for G0181 as mentioned below.
G0181 covers a provider’s supervision of a patient receiving home health services under a home health plan of care.
G0181 required the physician provider to supervise the care of a patient receiving the services of a Medicare eligible home health agency.
The coordinating physician provider adjusts medical therapy according to improvement or deterioration of the patient’s health status.
The patient is not present during supervision.
G0181 covers the complex care of patients who receive multidisciplinary care modalities requiring regular supervision by the provider. This includes;
- review of reports including laboratory studies;
- coordination with other providers involved in the patient’s care;
- telephone communication; and
- regular monitoring of progression with the plan of care.
Report G0181 only when the provider documents 30 minutes or more over a month’s time supervising a home health patient’s care.
G0182 CPT Code Description And Biling Guidelines
G0182 can be billed for hospice care supervision. If the patient is present, G0182 will be denied. The hospice needs to be medicare approved.
Multidisciplinary and complex and care modalities is required involving regular physician revision and/or development of care plans.
The total time of the service is 30 minutes or more and can be provided only once a calendar month.
The billing guidelines for G0182 are as follows. The G0182 services are provided in a Medicare eligible hospice agency; they include;
- review of reports including laboratory studies;
- telephone communication;
- regular monitoring of progression with the plan of care; and
- coordination with other providers involved in the patient’s care.
The coordinating physician provider who provides G0182 adjusts medical therapy according to improvement or deterioration of the patient’s health status.
The patient is not present during the G0182 supervision
Report G0182 when the provider documents 30 minutes or more over a month’s time supervising a hospice patient’s care..
Medicaid will not reimburse an attending physician for certifying the home health plan of care.
This is considered as already reimbursed to the attending physician through any evaluation and management services provided throughout the period of illness that the recipient is receiving home health care assistance.