Forum - Questions & Answers

Jan 8th, 2010 - kbarney

Assisted Living Facility Visits - Billing and Coding

Our physicians have never billed for the above, but it appears that the first of them has started. It would seem pretty straightforward to me, but I want to make sure that I have alll of my information correct. It would be billed using the 99324-99337 range of codes. Are these Medicare covered services? I would think that we will likely be seeing a lot more of these.

Jan 8th, 2010 - Codapedia Editor 1,399 

Assisted living

These are covered services. The only tricky thing is that sometimes, there are independent, free standing apartments and also assisted living on the same campus. If the patient lives independently, then use home visits. If the patient has the assistance described below, these codes. And of course, the place of service has to match.

The Medicare manual section is from:

Publication 100-04, Chapter 12, Section 30.6.14

30.6.14 - Home Care and Domiciliary Care Visits (Codes 99324- 99350)
(Rev. 775, Issued: 12-02-05, Effective: 01-01-06, Implementation: 01-03-06)
Physician Visits to Patients Residing in Various Places of Service
The American Medical Association’s Current Procedural Terminology (CPT) 2006 new patient codes 99324 – 99328 and established patient codes 99334 - 99337(new codes beginning January 2006), for Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services, are used to report evaluation and management (E/M) services to residents residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis. These CPT codes are used to report E/M services in facilities assigned places of service (POS) codes 13 (Assisted Living Facility), 14 (Group Home), 33 (Custodial Care Facility) and 55 (Residential Substance Abuse Facility). Assisted living facilities may also be known as adult living facilities.
Physicians and qualified nonphysician practitioners (NPPs) furnishing E/M services to residents in a living arrangement described by one of the POS listed above must use the level of service code in the CPT code range 99324 – 99337 to report the service they provide. The CPT codes 99321 – 99333 for Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services are deleted beginning January, 2006.
Beginning in 2006, reasonable and medically necessary, face-to-face, prolonged services, represented by CPT codes 99354 – 99355, may be reported with the appropriate companion E/M codes when a physician or qualified NPP, provides a prolonged service involving direct (face-to-face) patient contact that is beyond the usual E/M visit service for a Domiciliary, Rest Home (e.g., Boarding Home) or Custodial Care Service. All the requirements for prolonged services at § must be met.
The CPT codes 99341 through 99350, Home Services codes, are used to report E/M services furnished to a patient residing in his or her own private residence (e.g., private home, apartment, town home) and not residing in any type of congregate/shared facility living arrangement including assisted living facilities and group homes. The Home Services codes apply only to the specific 2-digit POS 12 (Home). Home Services codes may not be used for billing E/M services provided in settings other than in the private residence of an individual as described above.

Jan 5th, 2015 - N7OQW 1 

re: Assisted Living Facility Visits - Billing and Coding

I keep getting denied on my assisted living facility visits because I don't have an NPI for them. Assisted living facilities do not need an NPI so what would I use to bill the physician visits? I am using 99325 CPT® but what service location NPI would I use?

May 29th, 2015 - mhmg 1 

re: Assisted Living Facility Visits - Billing and Coding

does anyone have an answer to this question that was previously asked? I am having the same issue with the facility not having an NPI# nor will they obtain one.

May 29th, 2015 - LBAROGIANIS 250 

re: Assisted Living Facility Visits - Billing and Coding

What codes are you billing? Are you using POS 13?

Oct 28th, 2015 - trthel1 1 

re: Assisted Living Facility Visits - Billing and Coding

Yes, I would like help with this question to " Provider go to the Assisted Living Facility to provider care" how would this be billed on a 1500 form? I would think you need to add the POS 13 in box 24b and then in box 32 the service facility location information and then in box 32a it is requiring a NPI # of the facility and if they do not have one will the claim be denied with this information? CPT® code range 99324-99337

Dec 28th, 2015 - ambjstallings 1 

re: Assisted Living Facility Visits - Billing and Coding

How do you bill when the facility does not have an NPI? Could these be considered home visits if each patient resides in their own 'apartment'?

Jun 16th, 2016 - Clee40 1 

Assisted Living Facility Visits - Billing and Coding

What if the visit is for POS 13 and there is not a NPI# for the facility. Would you use the provider's group NPI for box 32A since there is not one for the facility?

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