How To Use HCPCS Code G0158

HCPCS code G0158 describes services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes. This code is used to identify the specific type of service provided and is essential for accurate medical coding and billing.

1. What is HCPCS G0158?

HCPCS code G0158 is a specific code used in medical coding to identify services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes. It is important to note that this code is only applicable for services provided by a qualified occupational therapist assistant and not by other healthcare professionals.

2. Official Description

The official description of HCPCS code G0158 is “Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes.” The short description for this code is “Hhc ot assistant ea 15.”

3. Procedure

1. The qualified occupational therapist assistant will assess the patient’s needs and develop a treatment plan.
2. They will provide therapy services to the patient in their home health or hospice setting.
3. The services provided may include therapeutic exercises, activities of daily living training, and other interventions to improve the patient’s functional abilities.
4. The therapist assistant will document the services provided, including the duration of each session.
5. These services are typically provided in 15-minute increments.

4. When to use HCPCS code G0158

HCPCS code G0158 should be used when a qualified occupational therapist assistant provides services in the home health or hospice setting. It is important to ensure that the services provided meet the specific criteria outlined in the code description.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G0158, healthcare providers need to document the following:

• The patient’s medical record should include the therapist assistant’s qualifications and credentials.
• The documentation should clearly indicate the services provided, including the specific interventions and techniques used.
• The duration of each session should be documented accurately.
• Any progress or changes in the patient’s condition should be noted.

6. Historical Information and Code Maintenance

HCPCS code G0158 was added to the Healthcare Common Procedure Coding System on January 01, 2011. Since its addition, 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

Medicare and other insurance providers may cover services billed under HCPCS code G0158. However, it is important to check with individual payers to determine their specific coverage policies and requirements. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G0158 should be billed:

1. A qualified occupational therapist assistant provides therapeutic exercises to a patient in their home health setting for 30 minutes.
2. An occupational therapist assistant provides activities of daily living training to a hospice patient for 45 minutes.
3. A therapist assistant provides interventions to improve a patient’s fine motor skills in their home health setting for 15 minutes.
4. An occupational therapist assistant provides cognitive therapy to a hospice patient for 60 minutes.
5. A qualified therapist assistant provides sensory integration therapy to a patient in their home health setting for 90 minutes.