How To Use HCPCS Code G0083

HCPCS code G0083 describes a moderate (45 minutes) care management home visit for an existing patient. This code is specifically used in a Medicare-approved CMMI model and is intended for services provided within a beneficiary’s home, domiciliary, rest home, assisted living, and/or nursing facility.

1. What is HCPCS G0083?

HCPCS code G0083 is a unique alphanumeric code that is used to identify a specific healthcare service or procedure. In this case, it represents a care management home visit for an existing patient that lasts for approximately 45 minutes.

2. Official Description

The official description of HCPCS code G0083 is “Moderate (45 minutes) care management home visit for an existing patient. For use only in a Medicare-approved CMMI model.” The short description for this code is “Care man h v ext pt 45 m.”

3. Procedure

1. The healthcare provider begins by scheduling a home visit with the existing patient.
2. During the visit, the provider assesses the patient’s medical condition and reviews their current care plan.
3. The provider may perform various care management activities, such as medication reconciliation, coordination of services, and patient education.
4. Throughout the 45-minute visit, the provider documents the patient’s progress and any changes made to their care plan.
5. After the visit, the provider may communicate with other healthcare professionals involved in the patient’s care to ensure continuity and coordination.

4. When to use HCPCS code G0083

HCPCS code G0083 should be used when a healthcare provider performs a moderate care management home visit for an existing patient. It is important to note that this code is only applicable in a Medicare-approved CMMI model and must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living, or nursing facility.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0083, healthcare providers need to ensure that they document the details of the care management home visit. This includes documenting the duration of the visit (45 minutes), the specific care management activities performed, and any changes made to the patient’s care plan. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0083 was added to the Healthcare Common Procedure Coding System on January 01, 2019. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0083 is payable by Medicare when provided within a Medicare-approved CMMI model. The pricing indicator code 13 indicates that the price for this service is established by carriers, meaning it is determined by individual carriers based on their discretion. The multiple pricing indicator code A signifies that this code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code G0083 should be billed:

1. An existing Medicare patient receives a 45-minute care management home visit from their healthcare provider to assess their chronic condition and update their care plan.
2. A patient residing in an assisted living facility requires a moderate care management home visit to address their complex medical needs and coordinate their care with other healthcare professionals.
3. A Medicare beneficiary receives a 45-minute care management home visit from a nurse practitioner to review their medication regimen and provide education on self-management of their chronic disease.
4. An existing patient who recently transitioned from a hospital to a nursing facility receives a care management home visit to ensure a smooth transition and continuity of care.
5. A patient with multiple chronic conditions receives a 45-minute care management home visit from a physician assistant to develop a comprehensive care plan and coordinate their healthcare services.