Wiki Community Health Worker services: Billing Medicare

[kimjones56]

Does anyone have info on the process of billing for CHW services under a family medicine clinic/MD?
We see that as of 1/1/2024, Medicaid will pay CHWs to provide "Community Health Integration Services" (G0019 & G0022), but are there additional codes for the actual home visits that our CHWs do several times a month for medically vulnerable patients?
We're looking at G0023, G0024, G0140, G0146.
Thank you !

 

[CARLA@PAYNENURSING.COM]

I have been using a CHW to help with diagnosis and SDOH with my patients with severe mental illness. Medicare allows G0019 monthly x 1 and G0022 can be billed up to 3 units per day without limitations on how many days per month. My question is how do you enter them on the claim form?

For example, patient is seen for initial visit 03/07 for 2 hours, there would be G0019 x 1 and G0022 x 2, then they see them again on 03/14 and 03/21 for 90 minutes each time. Each would be G0022 x 3 units. My coder could not find any information on how to bill the additional days of service that are within the same month. First, we tried billing all units together under one date of service at the end of the month, (G0019 x1unit and G0022 x 8units) it was rejected due to too many units on one date of service.

Called Medicare and they said they could not help because they are not coders.

We talked to another coder who also could not find any information. We then tried to follow how Medicaid said to do it, put each date of service as a separate line on the same claim form because G0022 is an add-on code for G0019. Medicare paid the G0019 x 1 and G0022 x 2 for one date of service and rejected the additional dates of service because they were not submitted as an add-on code?

Please help! We are so frustrated.

 

[RTabacco]

Because these codes are monthly. You might need to submit a 1500 on your own without going through an EHR. Or call your EHR and ask them how to do a monthly billing in their system.

The 1500 form has a date range listing. So you could just list the date of service as the start date and the end date. But what you want to do is set the start date to the 1st of the month and the end date as the last day of the month.

 

[Pdeibler]

a
Can someone confirm if the services provided by a CHW need to be done in direct contact with the patient or if coordination is also a billable service?

Often, these CHW are doing lots of work "behind the scenes" accessing resources, setting up profiles and such, that are for the patient but not done in direct contact with the patient.