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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.
| CERTIFICATION AND RECERTIFICATION |
| 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
| 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 (see sample
tracking tool below).
- 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.
Sample Billing Form:
Sample Tracking Tool:
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.
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