How To Use HCPCS Code G0180

HCPCS code G0180 describes the physician or allowed practitioner certification for Medicare-covered home health services under a home health plan of care. This code is used when the patient is not present during the certification process. It includes contacts with the home health agency and the review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care.

1. What is HCPCS G0180?

HCPCS code G0180 is used to identify the certification process for Medicare-covered home health services under a home health plan of care. It specifically refers to the certification conducted by a physician or allowed practitioner when the patient is not present. This code is important for ensuring that the initial implementation of the plan of care is properly reviewed and affirmed by the healthcare provider.

2. Official Description

The official description of HCPCS code G0180 is “Physician or allowed practitioner certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care.” The short description for this code is “Md certification hha patient.”

3. Procedure

1. The physician or allowed practitioner reviews the patient’s medical records and the proposed home health plan of care.
2. Contacts are made with the home health agency to gather additional information and discuss the plan of care.
3. The physician or allowed practitioner reviews reports of the patient’s status, which are required to affirm the initial implementation of the plan of care.
4. Based on the review and assessment, the physician or allowed practitioner provides the certification for the Medicare-covered home health services.

4. When to use HCPCS code G0180

HCPCS code G0180 should be used when a physician or allowed practitioner is certifying Medicare-covered home health services under a home health plan of care. It is specifically used when the patient is not present during the certification process. This code is important for documenting and billing the certification services provided by the healthcare provider.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0180, healthcare providers need to document the following:

• The patient’s medical records and the proposed home health plan of care
• Contacts made with the home health agency
• Reports of the patient’s status reviewed by the physician or allowed practitioner
• The certification provided by the healthcare provider

These documentation requirements are essential for proper billing and reimbursement for the certification services.

6. Historical Information and Code Maintenance

HCPCS code G0180 was added to the Healthcare Common Procedure Coding System on October 01, 2000. As of March 01, 2020, 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 code has been in use for several years without significant changes or updates.

7. Medicare and Insurance Coverage

HCPCS code G0180 is payable by Medicare. The pricing indicator code 11 indicates that the price for this code is established using national RVUs (Relative Value Units). The multiple pricing indicator code A means that this code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to understand the pricing and coverage guidelines set by Medicare or other insurers to ensure proper reimbursement for the certification services.

8. Examples

Here are five examples of when HCPCS code G0180 should be billed:

1. A physician reviews the medical records and certifies the home health services for a patient who is not present during the certification process.
2. An allowed practitioner contacts the home health agency and reviews reports of the patient’s status to affirm the initial implementation of the plan of care.
3. A physician reviews the proposed home health plan of care and provides the certification for Medicare-covered services for a patient who is unable to be present.
4. An allowed practitioner communicates with the home health agency and reviews the patient’s status reports to ensure the proper implementation of the plan of care.
5. A physician conducts a thorough review of the patient’s medical records and provides the certification for the home health services under a home health plan of care.