Care Plan Oversight (CPO)

Family physicians and other primary care and specialty physicians are frequently required to manage and coordinate complex medical cases to ensure quality and efficient use of health care resources, particularly in the inpatient setting.

In a similar way, Medicare has recognized this concept as it relates to home health care patients by paying physicians for their involvement in the initial certification, recurrent recertification, and care plan oversight functions.

The following table represents the HCPCS codes and narrative description of physician activities that are billable for patients receiving home health care under the Medicare benefit.

Certifications and Recertifications

HCPCS CODE	DESCRIPTION
G0180 - CERTIFICATION	Initial home health certification, also known as reviewing and signing the initial plan of care
G0179 - RECERTIFICATION	Recertification of the plan of care – if the patient's care continues for an additional 60 days, the physician must review and sign a recertification plan of care
G0181 - CARE PLAN OVERSIGHT (CPO) (formerly CPT 99375)	Home health CPO is indicated for the supervision of a patient under the care of a Medicare-certified home health agency. (Patient is not present). Oversight is indicated for the patient whose care is complex and involves multiple disciplines, thereby requiring regular physician contact

Reimbursement: Rates effective as of Medicare's 2004 allowable fees

Certifications and Recertifications

CPT CODE	Miami - Dade FL	Broward Co. FL	Rest of FL	Pittsburgh PA	Steubenville OH
G0181 - CPO	$130.54	$125.95	$122.53	$117.96	$126.00
G0180 - CERTIFICATION	$77.57	$74.99	$72.23	$69.71	$73.57
G0179 - RECERTIFICATION	$59.91	$58.00	$55.77	$53.91	$57.02

Care Plan Oversight activities that are billable include:

Communication with interdisciplinary team and pharmacist, including phone calls or other verbal communication
Review of patient status reports
Modification of plan of care, including the review and signing of modification orders
Review of lab results, reports, and records

Care Plan Oversight billing criteria:

Patient must be receiving Medicare covered home health services
Physician must demonstrate that 30 minutes or more of supervision to the patient's care has occurred (sample)
Physician must have seen the patient at least once during the six-month period prior to Care Plan Oversight billing
Physician is the only physician billing for Care Plan Oversight for the particular patient
The physician billing for Care Plan Oversight must be the physician who signed the home health plan of care
Bill must include the Medicare provider number of the patient's home health agency

Important notes:

Always retain the home care Plan of Treatment in the patient's medical record
Minimum billable time is 30 cumulative minutes dedicated to the patient's care over a 30-day period
Care Plan Oversight activities cannot relate to surgery during the immediate post-op period

Please call the Associated Home Health agency in your location for more instructions or if you have any questions regarding billing, tracking or the reimbursement

Care Plan Oversight (CPO)

Reimbursement: Rates effective as of Medicare's 2004 allowable fees

Care Plan Oversight activities that are billable include:

Care Plan Oversight billing criteria:

Important notes:

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