Certification of Home Health Agency Services for Medicare

February 25th, 2009 - Codapedia Editor
Categories:   Coding   HCPCS Coding   Medicare  
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In 2001, Medicare added two new HCPCS codes to describe certification and recertification of home health services performed by a physician.  A qualified NPP  may not provide this service because only a physician may order home health services for a patient.  

There are two codes, G0179 and G0180, which were developed in 2001.

G0180: Physician 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 to affirm the initial implementation of the plan of care that meets patients needs, per certification period

G0179: Physician re-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 to affirm the initial implementation of the plan of care that meets patients needs, per re-certification period

Rarely does Medicare pay for a non-face-to-face services provided by a physician. This is one of the instances in which a physician can be paid for those services.  In order to bill for the services, a physician may not have a financial relationship of any significance with the home health agency.  The physician is being paid for planning and developing the plan for the home health services.  They must create and review the plan of care and the data collected by the home health agency and maintain a record of this in their own records.  This includes communication with the HHA and review of the patient’s response to treatment.

Unlike care plan oversight, there is no minimum time spent in the calendar month to bill for this service.  The recertification code may only be billed 60 days after the first.  Document phone calls, data review and recertification in the medical record.  

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Comments

Apr 8th, 2018 - MLRowe

Thank you!

This is a great explanation of the meaning of these codes, especially G0180. I've been scouring the internet for a very precise breakdown of the definition, as I'm a college student and I did not understand the meaning of "patient not present". This website is an excellent tool for someone like me and I'm so grateful there are wonderful people in the world who make sites such as this for communication, education, and allocation.

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