Assisted Living Visits

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62
Location
Harrisburg, PA
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0
Hello,

I have a provider who is seeing patient at an Assisted Living facility. This facility has independent living and personal care. He sees the patient's in the personal care, but then also sees the independent living patients in the personal care facility. He is billing the independent living patient visits as Office visits 99212-99215. I do not think this is correct, but I am not sure if the assisted living facility codes are correct either. Also, the home visit codes might not be correct either because even though the patients have their own town houses and are independent living, they do get 2 meals per day, weekly housekeeping and linen service, use of all the community amenities, etc.

I read somewhere about the provider renting a space in the facility which can change what they are billing, but I cannot find this anywhere either.

I have looked in the Medicare Claims processing manual and CPT but I cannot find anything.

Any help would be appreciated!
 

Chelle-Lynn

True Blue
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706
Location
Modesto, CA
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CPT codes 99324–99328 and 99334–99337 for Domiciliary Rest Home (e.g., Boarding Home) or Custodial Care Services, are used to report services to residents residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis.

These CPT codes are used to report E/M services in facilities assigned places of service (POS) codes:
  • 13 (Assisted Living Facility)
  • 14 (Group Home)
  • 33 (Custodial Care Facility)
  • 55 (Residential Substance Abuse Facility).
  • Assisted living facilities may also be known as adult living facilities.

CPT codes 99341-99350 for Home Services are used to report E/M services furnished to a patient residing in his or her own private residence (e.g., private home, apartment, town home) and not residing in any type of congregate/shared facility living arrangement including assisted living facilities and group homes.

The Home Services codes apply only to the specific 2-digit POS 12 (Home). Home Services codes may not be used for billing E/M services provided in settings other than in the private residence of an individual as described above.

Based on what you are describing the patient would fall under assisted living facility as while they are living in an independent apartment it is still considered part of the assisted living facility where room & board or assistance is provided with daily living. We would bill with
99324–99328 and 99334–99337 as the service is outside of the office and not within their personal home.
 
Messages
62
Location
Harrisburg, PA
Best answers
0
CPT codes 99324–99328 and 99334–99337 for Domiciliary Rest Home (e.g., Boarding Home) or Custodial Care Services, are used to report services to residents residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis.

These CPT codes are used to report E/M services in facilities assigned places of service (POS) codes:
  • 13 (Assisted Living Facility)
  • 14 (Group Home)
  • 33 (Custodial Care Facility)
  • 55 (Residential Substance Abuse Facility).
  • Assisted living facilities may also be known as adult living facilities.

CPT codes 99341-99350 for Home Services are used to report E/M services furnished to a patient residing in his or her own private residence (e.g., private home, apartment, town home) and not residing in any type of congregate/shared facility living arrangement including assisted living facilities and group homes.

The Home Services codes apply only to the specific 2-digit POS 12 (Home). Home Services codes may not be used for billing E/M services provided in settings other than in the private residence of an individual as described above.

Based on what you are describing the patient would fall under assisted living facility as while they are living in an independent apartment it is still considered part of the assisted living facility where room & board or assistance is provided with daily living. We would bill with
99324–99328 and 99334–99337 as the service is outside of the office and not within their personal home.

What if the provider would rent a space in the assisted living facility, would it be appropriate to bill for an office visit 99212-99215?
 

thomas7331

True Blue
Messages
2,280
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5
If the provider rents a space then it would be appropriate to bill that as an office place of service since they are incurring a cost to operate from that location, but keep in mind that it would also be necessary to credential that location with the payers as well as provide the staff, insurance coverage and any other required support or regulatory compliance necessary to operate a medical practice from that site.
 
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