November 7, 2019
Per CMS coding guidelines for home health agencies that render professional services in the home health or hospice setting, there are certain Healthcare Common Procedure Coding System (HCPCS) codes that are to be billed on a facility claim (CMS-1450/837I) only. The codes in question include the following:
- Physical Therapy services (codes G0151-G0159)
- Occupational Therapy services (codes G0152, G0158, G0160)
- Speech Language/Pathology services (G0153, G0161)
- Skilled Nursing visits (codes G0299, G0300)
- Care Plan Oversight (codes G0162, G0163, G0493-G0496)
- Medical Social Services (code G0155)
- Home Health Aid visits (code G0156)
- Hospice evaluation and counseling (code G0337)
In addition, Hospital Emergency Room visits and Hospital Outpatient Visits rendered by hospital employed providers must also be billed on a facility claim (CMS-1450/837I). These services include:
- Level 1-5 Emergency department visits (codes G0380-G0384)
- Hospital Outpatient visits (code G0463)
All of these codes should be reported on a facility claim and not on a professional claim when rendered by a home health agency or hospital employed providers. Submission of these codes on a professional claim will be denied reimbursement.