How To Use HCPCS Code G0060

HCPCS code G0060 describes a specific service within the field of allergy/immunology. This code is used to identify the Allergy/Immunology MIPS Specialty Set, which is a set of measures designed to assess the quality of care provided by healthcare professionals in the field of allergy and immunology. In this article, we will explore the details of HCPCS code G0060, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0060?

HCPCS code G0060 is specifically used to identify the Allergy/Immunology MIPS Specialty Set. This set of measures is designed to evaluate the quality of care provided by healthcare professionals specializing in allergy and immunology. It includes various measures related to the diagnosis, treatment, and management of allergies and immune system disorders. The use of this code indicates that the healthcare professional has performed the necessary measures to assess and improve the quality of care in this specialty.

2. Official Description

The official description of HCPCS code G0060 is “Allergy/immunology MIPS specialty set.” This description accurately reflects the purpose and scope of this code. The short description of this code is “Allergy/immunology ss,” which provides a concise summary of the specialty set.

3. Procedure

1. The provider should follow the specific measures included in the Allergy/Immunology MIPS Specialty Set.
2. These measures may include diagnostic tests, treatment interventions, patient education, and follow-up care.
3. Each measure within the specialty set has its own specific requirements and guidelines that the provider must adhere to.
4. The provider should document the completion of each measure in the patient’s medical record.
5. The measures are designed to assess and improve the quality of care provided by healthcare professionals in the field of allergy and immunology.

4. When to use HCPCS code G0060

HCPCS code G0060 should be used when a healthcare professional performs the measures included in the Allergy/Immunology MIPS Specialty Set. This code is specific to the field of allergy and immunology and should only be used in the context of this specialty. It is important to ensure that the measures performed align with the requirements and guidelines outlined in the specialty set.

5. Billing Guidelines and Documentation Requirements

When billing for services associated with HCPCS code G0060, healthcare providers should ensure that they meet the necessary documentation requirements. This may include documenting the completion of each measure within the specialty set, providing supporting documentation for the services rendered, and maintaining accurate and detailed records of the patient’s diagnosis, treatment, and progress. It is essential to follow the specific billing guidelines provided by the payer to ensure proper reimbursement for the services provided.

6. Historical Information and Code Maintenance

HCPCS code G0060 was added to the Healthcare Common Procedure Coding System on January 01, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This suggests that the code has remained unchanged since its addition to the system.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G0060 may vary depending on the payer, including Medicare and other insurance providers. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers. The multiple pricing indicator code is 9, which indicates that the value for this code is not established. It is essential to verify the coverage and reimbursement policies of the specific payer before billing for services associated with this code.

8. Examples

Here are five examples of scenarios in which HCPCS code G0060 should be billed:

1. A patient with a history of severe allergies visits an allergist for a comprehensive evaluation, including skin prick testing, pulmonary function testing, and immunotherapy counseling.
2. A pediatric patient with suspected food allergies undergoes a comprehensive evaluation, including a detailed medical history, physical examination, and allergen-specific IgE testing.
3. A patient with a diagnosed immune system disorder receives ongoing monitoring and management from an immunologist, including regular laboratory tests, medication adjustments, and patient education.
4. A patient with chronic urticaria seeks treatment from an allergist, who performs a thorough evaluation, prescribes appropriate medications, and provides guidance on trigger avoidance.
5. A patient with a suspected drug allergy undergoes a comprehensive evaluation, including a detailed history, physical examination, and drug provocation testing under the supervision of an allergist.