How To Use HCPCS Code G2108

HCPCS code G2108 describes the specific circumstances under which a patient aged 66 or older is eligible for coverage in institutional special needs plans (SNP) or residing in long-term care facilities. This code is used to identify patients who have been in a long-term care facility for more than 90 consecutive days during the measurement period and have a place of service (POS) code of 32, 33, 34, 54, or 56. It is important for medical coders to understand the meaning and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS G2108?

HCPCS code G2108 is a specific code used in medical coding to identify patients who are aged 66 or older and meet certain criteria for coverage in institutional special needs plans (SNP) or residing in long-term care facilities. This code is used to indicate that the patient has been in a long-term care facility for more than 90 consecutive days during the measurement period and has a place of service (POS) code of 32, 33, 34, 54, or 56.

2. Official Description

The official description of HCPCS code G2108 is “Patient age 66 or older in institutional special needs plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period.” The short description for this code is “Pt 66+ SNP or LTC POS > 90d.”

3. Procedure

1. Patients who are aged 66 or older and meet the eligibility criteria for institutional special needs plans (SNP) or long-term care must be identified.
2. The patient’s place of service (POS) code should be checked to ensure it is one of the following: 32, 33, 34, 54, or 56.
3. The patient’s length of stay in the long-term care facility should be determined to be more than 90 consecutive days during the measurement period.
4. If all the criteria are met, HCPCS code G2108 should be assigned to indicate the patient’s eligibility for coverage in institutional special needs plans (SNP) or residing in long-term care.

4. When to use HCPCS code G2108

HCPCS code G2108 should be used when a patient aged 66 or older meets the specific criteria for coverage in institutional special needs plans (SNP) or residing in long-term care. The patient must have been in a long-term care facility for more than 90 consecutive days during the measurement period and have a place of service (POS) code of 32, 33, 34, 54, or 56.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G2108, healthcare providers need to ensure that the patient’s age, length of stay in the long-term care facility, and place of service (POS) code are accurately documented in the medical records. This information is essential for proper billing and reimbursement. Providers should also follow any specific billing guidelines or requirements set forth by Medicare or other insurance carriers.

6. Historical Information and Code Maintenance

HCPCS code G2108 was added to the Healthcare Common Procedure Coding System on January 01, 2020. It has an effective date of January 01, 2024, and will be terminated on December 31, 2023. There have been no maintenance actions taken for this code, as indicated by the action code D, which means to discontinue the procedure or modifier code.

7. Medicare and Insurance Coverage

HCPCS code G2108 is covered by Medicare and other insurance carriers. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This could be due to the service not being covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established. Providers should refer to Medicare guidelines and fee schedules for specific pricing information.

8. Examples

Here are five examples of when HCPCS code G2108 should be billed:

1. An 80-year-old patient has been residing in a long-term care facility with a place of service (POS) code of 33 for 120 consecutive days during the measurement period.
2. A 70-year-old patient is enrolled in an institutional special needs plan (SNP) and has been in a long-term care facility with a place of service (POS) code of 54 for 100 consecutive days during the measurement period.
3. A 75-year-old patient has been residing in a long-term care facility with a place of service (POS) code of 32 for 150 consecutive days during the measurement period.
4. An 85-year-old patient is enrolled in an institutional special needs plan (SNP) and has been in a long-term care facility with a place of service (POS) code of 56 for 95 consecutive days during the measurement period.
5. A 66-year-old patient has been residing in a long-term care facility with a place of service (POS) code of 34 for 110 consecutive days during the measurement period.