How To Use HCPCS Code G2014

HCPCS code G2014 describes limited (30 minutes) care plan oversight services provided within a beneficiary’s home, domiciliary, rest home, assisted living, and/or nursing facility. This code is specifically used in a Medicare-approved CMMI model and must be furnished within 90 days following discharge from an inpatient facility. It can be used up to 9 times and is not applicable for services provided in an emergency situation where immediate medical attention is required.

1. What is HCPCS G2014?

HCPCS code G2014 is used to identify limited (30 minutes) care plan oversight services provided within a beneficiary’s home, domiciliary, rest home, assisted living, and/or nursing facility. This code is only applicable in a Medicare-approved CMMI model and is used to track and bill for the time spent by a healthcare provider in overseeing and managing a patient’s care plan following discharge from an inpatient facility.

2. Official Description

The official description of HCPCS code G2014 is “Limited (30 minutes) care plan oversight. For use only in a Medicare-approved CMMI model.” The short description for this code is “Post-d/c care plan overs 30m.”

3. Procedure

1. After a patient is discharged from an inpatient facility, the healthcare provider will schedule a follow-up visit within 90 days.
2. During the follow-up visit, the provider will spend up to 30 minutes reviewing and overseeing the patient’s care plan.
3. This includes reviewing medical records, coordinating with other healthcare professionals involved in the patient’s care, and making any necessary adjustments to the care plan.
4. The provider may also communicate with the patient or their caregiver to ensure understanding and compliance with the care plan.
5. Documentation of the time spent on care plan oversight is essential for accurate billing.

4. When to use HCPCS code G2014

HCPCS code G2014 should be used when a healthcare provider is providing limited (30 minutes) care plan oversight services within a beneficiary’s home, domiciliary, rest home, assisted living, and/or nursing facility. These services must be furnished within 90 days following discharge from an inpatient facility and no more than 9 times. It is important to ensure that the services are provided within the context of a Medicare-approved CMMI model.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2014, healthcare providers need to document the time spent on care plan oversight, including reviewing medical records, coordinating with other healthcare professionals, and communicating with the patient or caregiver. The documentation should clearly indicate the date of service, the duration of care plan oversight (up to 30 minutes), and any adjustments made to the care plan. It is important to maintain accurate and detailed records to support the billing of this code.

6. Historical Information and Code Maintenance

HCPCS code G2014 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 G2014 is payable by Medicare. The pricing indicator code 13 indicates that the price for this service is established by carriers, based on carrier discretion. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology. It is important to check with individual insurance providers to determine coverage and reimbursement policies for this specific code.

8. Examples

Here are five examples of when HCPCS code G2014 should be billed:

1. A patient is discharged from a hospital and requires ongoing care plan oversight within their assisted living facility. The healthcare provider spends 30 minutes reviewing and coordinating the patient’s care plan.
2. A patient is discharged from a nursing facility and requires follow-up care plan oversight within their home. The healthcare provider spends 30 minutes reviewing the patient’s medical records and communicating with the patient’s primary care physician.
3. A patient is discharged from a rest home and requires care plan oversight within their domiciliary. The healthcare provider spends 30 minutes reviewing the patient’s care plan and making adjustments based on the patient’s current condition.
4. A patient is discharged from an inpatient facility and requires care plan oversight within their nursing facility. The healthcare provider spends 30 minutes coordinating with the nursing staff and reviewing the patient’s progress.
5. A patient is discharged from a domiciliary and requires care plan oversight within their home. The healthcare provider spends 30 minutes communicating with the patient’s caregiver and ensuring compliance with the care plan.