Home Services

RebeccaWoodward*

True Blue
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30.6.14.1 - Home Services (Codes 99341 - 99350)
(Rev. 1, 10-01-03)
B3-15515, B3-15066
A. Requirement for Physician Presence
Home services codes 99341-99350 are paid when they are billed to report evaluation and management services provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.
B. Homebound Status
Under the home health benefit the beneficiary must be confined to the home for services to be covered. For home services provided by a physician using these codes, the beneficiary does not need to be confined to the home. The medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit.
C. Fee Schedule Payment for Services to Homebound Patients under General Supervision
Payment may be made in some medically underserved areas where there is a lack of medical personnel and home health services for injections, EKGs, and venipunctures that are performed for homebound patients under general physician supervision by nurses and paramedical employees of physicians or physician-directed clinics. Section 10 provides additional information on the provision of services to homebound Medicare patients.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Example from another site...
Q. The office nurse gave ceftriaxone (Rocephin) injections to a Medicare patient during 3 home visits. Since the nurse is not a provider, which code should I use to charge for the visits? The patient also came into the office for the injections only. The nurse performed no other service during that visit. The patient provided the ceftriaxone. Would I only charge the injection procedure? Would I charge a nurse visit (99211) as well?

Since a 99211 is only rendered in an office or outpatient setting, you cannot use 99211 for the home visit. Since you were not with the nurse when the home visit was made and Medicare stipulates that only a provider (MD, DO, physician assistant, or nurse practitioner) can make a home visit, there is no charge associated with the home visit. As to the office visit where only an injection was rendered by your staff member and the patient presented with the injectable drug, the only charge that you can make on that visit is the 90772 for the injection. You cannot bill a nurse visit with a 90772 per Medicare.
 

toriesurf

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Home visits

Hi Rebecca,
In the instance where a nurse gave a patient a Rocephin injection AT THEIR HOME, is there a way to bill for the injection and the drug?
Thank you for any help you can provide.
 
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