How To Use HCPCS Code G9480

HCPCS code G9480 describes the admission to the Medicare Care Choice Model Program (MCCM). This code is used to identify the specific service of admitting a patient to the MCCM program. In this article, we will explore the details of HCPCS code G9480, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9480?

HCPCS code G9480 is used to indicate the admission to the Medicare Care Choice Model Program (MCCM). This program aims to provide Medicare beneficiaries with greater flexibility in receiving care and services. It allows beneficiaries to receive care from participating hospices while still receiving curative treatments for their conditions.

2. Official Description

The official description of HCPCS code G9480 is “Admission to medicare care choice model program (mccm)”. The short description is “Admission to mccm”.

3. Procedure

1. The provider initiates the admission process by assessing the patient’s eligibility for the Medicare Care Choice Model Program.
2. If the patient meets the eligibility criteria, the provider completes the necessary paperwork and documentation for the admission.
3. The provider submits the admission request to the appropriate Medicare administrative contractor (MAC) for review and approval.
4. Once the admission is approved, the provider notifies the patient and begins coordinating the necessary care and services.

4. When to use HCPCS code G9480

HCPCS code G9480 should be used when a patient is being admitted to the Medicare Care Choice Model Program (MCCM). It is important to ensure that the patient meets the eligibility criteria for the program before using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9480, healthcare providers should ensure that they have the necessary documentation to support the admission to the Medicare Care Choice Model Program. This may include documentation of the patient’s eligibility for the program, the completed admission paperwork, and any other relevant documentation as required by Medicare or other insurers.

6. Historical Information and Code Maintenance

HCPCS code G9480 was added to the Healthcare Common Procedure Coding System on January 01, 2016. 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

HCPCS code G9480 is covered by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is bundled or not covered separately. The multiple pricing indicator code is 9, which means that the value for this code is not established. It is important for healthcare providers to verify the coverage and reimbursement policies of other insurance carriers to determine if they also cover this service.

8. Examples

Here are five examples of when HCPCS code G9480 should be billed:

1. A patient with a terminal illness is admitted to the Medicare Care Choice Model Program for hospice care while still receiving curative treatments.
2. An eligible Medicare beneficiary is admitted to the MCCM program after meeting all the necessary criteria.
3. A healthcare provider submits the admission request for a patient who has chosen to participate in the Medicare Care Choice Model Program.
4. A patient who meets the eligibility requirements for the MCCM program is admitted by a participating hospice provider.
5. A provider coordinates the admission process for a patient who wishes to receive care from a participating hospice while still receiving curative treatments.