How To Use HCPCS Code G0490

HCPCS code G0490 describes a face-to-face home health nursing visit provided by a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) in an area with a shortage of home health agencies. This code is specifically limited to registered nurses (RNs) or licensed practical nurses (LPNs) only.

1. What is HCPCS G0490?

HCPCS code G0490 is used to identify a home visit by an RN or LPN provided by a RHC or FQHC in an area where there is a shortage of home health agencies. This code is specific to nursing services and is not applicable for other healthcare professionals or services.

2. Official Description

The official description of HCPCS code G0490 is “Face-to-face home health nursing visit by a rural health clinic (RHC) or federally qualified health center (FQHC) in an area with a shortage of home health agencies.” The short description is “Home visit RN, LPN by RHC/FQ.”

3. Procedure

1. The provider schedules a home visit for the patient.
2. The RN or LPN from the RHC or FQHC travels to the patient’s home.
3. During the visit, the nurse provides necessary nursing care, including assessments, medication administration, wound care, and patient education.
4. The nurse documents the services provided and any relevant patient information.
5. After the visit, the nurse may follow up with the patient as needed.

4. When to use HCPCS code G0490

HCPCS code G0490 should be used when a face-to-face home health nursing visit is provided by a RHC or FQHC in an area where there is a shortage of home health agencies. This code is limited to RNs or LPNs only and should not be used for other healthcare professionals or services.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0490, healthcare providers need to document the following:

• Date of the home visit
• Name and credentials of the RN or LPN providing the service
• Description of the nursing services provided
• Any medications administered
• Wound care procedures, if applicable
• Any patient education provided

Providers should also ensure that the documentation supports the medical necessity of the home visit and the specific services provided.

6. Historical Information and Code Maintenance

HCPCS code G0490 was added to the Healthcare Common Procedure Coding System on April 01, 2016. 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

The coverage for HCPCS code G0490 is determined by the carrier judgment, indicated by the coverage code C. Medicare and other insurance providers may have their own guidelines and policies regarding the coverage and reimbursement for this code. The pricing indicator code for G0490 is 13, which means the price is established by carriers based on individual determination and carrier discretion. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0490 should be billed:

1. A patient residing in a rural area with limited access to home health agencies requires a home visit by an RN from a RHC to receive wound care.
2. An elderly patient with multiple chronic conditions needs regular monitoring and medication administration by an LPN from an FQHC due to the lack of available home health agencies in the area.
3. A patient recovering from surgery requires post-operative care and education provided by an RN from a RHC in an underserved home health area.
4. A patient with a complex medical condition requires ongoing nursing assessments and medication management by an LPN from an FQHC in a region with limited home health agency options.
5. A patient with a chronic illness needs regular home visits by an RN from a RHC for disease management and patient education in an area with a shortage of home health agencies.