New Benefit Enhancement for 2019 Care Management Home Visits

New Benefit Enhancement for 2019 Care Management Home Visits

Effective Jan. 1, 2019, providers who are participating in Next Generation Accountable Care Organizations (NGACOs) are gaining a new covered benefit enhancement to offer their patients who are not otherwise covered by original fee-for-service (FFS) Medicare.

Benefit enhancements are conditional waivers of certain Medicare payment requirements. For 2018, benefit enhancements include:

  • Three-Day Skilled Nursing Facility Rule Waiver
  • Post-Discharge Home Visits Waiver
  • Telehealth Expansion Waiver

Care Management Home Visits

In 2019, Medicare patients will also be eligible to receive up to two care management home visits within 90 days of seeing the the NGACO participant and preferred provider who initiated a care treatment plan for them.

Covered items and services include those already covered under Medicare Part B and furnished incident-to the professional services of a physician or other practitioner. Medicare will waive the direct supervision requirement so services and supplies may be furnished by auxiliary personnel under the billing physician’s or other billing practitioner’s general supervision.

The items and services provided as part of these care management home visits are intended to supplement, not substitute, visits to a primary care provider or specialist in a traditional healthcare setting, according to the Centers for Medicare & Medicaid Services (CMS). This is not a home health benefit; patients eligible to receive home health services will not be eligible for this benefit enhancement.

Coding Care Management Home Visits

HCPCS Level II codes for the Care Management Home Visit services furnished by NGACO providers are:

• G0076: Brief (20 minutes) care management home visit for a new patient. For use only in a Medicare-approved Center for Medicare & Medicaid Innovation (CMMI) model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0077: Limited (30 minutes) care management home visit for a new patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

G0078: Moderate (45 minutes) care management home visit for a new patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0079: Comprehensive (60 minutes) care management home visit for a new patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0080: Extensive (75 minutes) care management home visit for a new patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0081: Brief (20 minutes) care management home visit for an existing patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0082: Limited (30 minutes) care management home visit for an existing patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0083: Moderate (45 minutes) care management home visit for an existing patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0084: Comprehensive (60 minutes) care management home visit for an existing patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0085: Extensive (75 minutes) care management home visit for an existing patient. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0086: Limited (30 minutes) care management home care plan oversight. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

• G0087: Comprehensive (60 minutes) care management home care plan oversight. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility.)

Billing Care Management Home Visits

Beginning Jan. 1, 2019, submit these codes on Type of Bill: 85X, with revenue codes 96X, 97X, or 98X. The payment rates will be in the Medicare Physician Fee Schedule (MPFS). However, Medicare will reimburse the lesser of the billed charge or MPFS rate for Critical Access Hospital Method II providers billing on Type of Bill 85X, with revenue codes 96X, 97X, or 98X.

 


Source:

CMS, MLN Matters 10824, Aug. 10, 2018

Renee Dustman
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Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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