Forum - Questions & Answers
Recertification for Home Health Services
Medicare created G0179 to be billed for recertification for Home Health Services. Is there a comparible CPT code that can be used for Non-Medicare insurers? I have a private payor - Aetna denying G0179 stating this is not a valid code.
Thanks
Lynn
Aetna denying something???
Go figure....many commercial insurers do not pay this. Even though the patient is on home care does not mean they cannot come in to the office for a visit that can be charged.
home health
Home health is a Part A service for Medicare beneficiaries. The physician component of this benefit includes certification and re-certification. The home health agency recertification code is used after a patient has received services for at least 60 days (or one certification period) when the physician signs the certification after the initial certification period. The home health agency recertification code will be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapses and requires a new plan of care to start a new episode.
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 patient's needs, per re-certification period.
If the patient is not in Medicare home health benefit, submit your scenario to private payer.
Home health certification for commercial patient
There is equivalent CPT code that corresponds to G0179 and G0180. Some commercial carriers may pay, most will not.
re: Home health certification for commercial patient
if there is a CPT® code equivalent for the G0179 and G0180 code that commercial insurance MIGHT pay. What is that code?
re: Home health certification for commercial patient
For commercial payors (non Medicare) we use CPT® 99374 - 99375.