G0180 equivalent for commercial insurances

GosiaM

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Looking for the advice regarding:
What code should I use for signing/filling out the Home Health Certification and Plan of care when billing commercial insurance (BCBS, UHC, Aetna)? For Medicare we use G0180 (our providers are hospitalist so they sign the initial certifications only). Thank you in advance.
 

Pam Brooks

True Blue
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There is no equivalent code for that service; it's specifically a Medicare program/code and covered service. Some commercial payers will reimburse, and some won't. We bill the G0179 or G0180 to all payers, to be consistent for all patients and compliant. If it's not covered, our contracts with our payers will make it provider responsibility. If you bill a 94999 (unlisted E&M code), you're going to get a denial anyway.
 
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