Don’t Wait to Implement April Code Update

Don’t Wait to Implement April Code Update

Code changes for the April update to the 2019 Medicare Physician Fee Schedule Database (MPFSDB) are effective for dates of service on and after Jan. 1, 2019. Medicare Administrative Contractors (MAC) will not search their files to retract payment for claims already paid or to retroactively pay claims. To ensure proper claims payment, providers will need to bring applicable claims to the attention of their MAC.

The Centers for Medicare & Medicaid Services (CMS) has added new HCPCS Level II codes (G2001-G2009 and G2013-G2015) to the 2019 MPFSDB and updated HCPCS Level II code G9987, which was included in the October 2018 update to the MPFSDB. Code descriptions and changes are shown in Table A.

News for Next Gen ACO Providers

Providers who are participating in Next Generation Accountable Care Organizations (NGACOs) and submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries should take note of the new G codes.

For dates of service on and after April 1, 2019, MACs will allow NGACO, including the Vermont (VT) ACO, to post discharge home visit claims for licensed clinicians under the general supervision of an NGACO or VT ACO provider when this benefit enhancement is elected by the provider and reported with the applicable G code. This applies to Type of Bill (TOB) 85X, revenue codes 96X, 97X, and 98X.

Medicare will reimburse Critical Access Hospital Method II providers billing on TOB 85X with revenue codes 96X, 97X, and 98X based on the lesser of the billed charge or the MPFS rate.

Note that MACs will reject or return as unprocessable a claim, or separate claims with the same DOS, that contains both a Post Discharge Home Visit HCPCS Level II code and a Care Management Home Visit HCPCS Level II code.

Table A: HCPCS Level II codes for the April 2019 update to the MPFSDB

Code Description Action
G9987 Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code Assistant Surgery, Co-Surgeon, & Team Surgeon indicator = 9
G2001 Brief (20 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99341
G2002 Limited (30 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99342
G2003 Moderate (45 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99343
G2004 Comprehensive (60 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99344
G2005 Extensive (75 minutes) in-home visit for a new patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99345
G2006 Brief (20 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99347
G2007 Limited (30 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99348
G2008 Moderate (45 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99349
G2009 Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99350
G2013 Extensive (75 minutes) in-home visit for an existing patient post-discharge. 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 within 90 days following discharge from an inpatient facility and no more than 9 times. All MPFS indicators and RVUs = 99345
G2014 Limited (30 minutes) 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 within 90 days following discharge from an inpatient facility and no more than 9 times.) All MPFS indicators and RVUs = 99339
G2015 Comprehensive (60 mins) 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 within 90 days following discharge from an inpatient facility.) All MPFS indicators and RVUs = 99340

 


sources

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10907.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R216DEMO.pdf

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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