Need Medicaid Home Health Care CPT Codes

neha.bhatnagar

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Mumbai, Maharashtra
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I want to know how to code for Home health care/Care plan oversight services for Medicaid patients. Till now we were using CPT 99374 & 99375 to code these services.

But now Medicaid has denied stating CPT 99374 & 99375 are invalid/Inactive/Expired Codes & we need to submit valid CPTs for Medicaid.

We cannot use G0179 & G0180 as these codes are for Medicare.

Did anyone aware of the revised codes for Home health care/Care plan oversight services for Medicaid ?

Please Help.

Regards,
Neha Bhatnagar CPC, CPC-H
 

RebeccaWoodward*

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North Carolina
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Our local Medicaid has a policy on this. It requires a minimum of 30 minutes...

Countable Services

The following activities are countable services toward the 30-minute minimum requirement for CPO:

-Review of charts, reports, treatment plans, or lab or study results, except for the initial interpretation or review of lab or study results that were ordered during or associated with a face-to-face encounter.

-Telephone calls with other health care professionals (not employed in the same practice) involved in the care of the patient.

-Team conferences (time spent per individual patient must be documented).

-Telephone or face-to-face discussions with a pharmacist about pharmaceutical therapies.

-Medical decision making.

-Activities to coordinate services are countable if the coordination activities require the skills of a physician

Billing

The following CPT codes must be used to bill CPO:

CPT code 99375, physician supervision of a patient under care of home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of the care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more

CPT code 99378, physician supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of the care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more

One thing to add: Claims for patients who are Medicare/Medicaid eligible must be submitted to Medicare (G codes). Medicaid will pay applicable deductibles and coinsurance. If CPO service is not covered by Medicare, the service must meet Medicaid coverage criteria for reimbursement.
 
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neha.bhatnagar

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Mumbai, Maharashtra
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Medicaid denying CPT 99375-99378

Hi Rebecca,

Thanks for replying

But as per our local Medicaid policy they are also denying 99375 & 99378 for same reason that the CPTs are invalid/inactive for Medicaid. And they have provided us site reference where we can check for valid CPT Home health care CPTs.
I cant find any CPTs in the link provided by them. I am forwarding u the same link.
www.njmmis.com/hospitalinfo.aspx

The CPTs 99374-99378 are not listed in their CPTHCPCSCODES list also.

If u find something please let us know.
Thanks a lot.
Regards,
Neha Bhatnagar, CPC, CPC-H
 

katzter44

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Medicaid denials for 99378 requesting a modifier

I need some information. I am receiving claims back billed to Medicaid for 99378 stating a modifier is needed?

CPT Units Billed Allow Pay Deduct Coins Copay Oth PR Reas/Remk
Service Dates Contr WHold Global Cap Oth CO Denied Incent Reas/Remk
G0181 1.000 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
05/03/2017 to 05/03/2017 $0.00 $0.00 $0.00 $0.00 $0.00 $200.00 $0.00 CO182, N657, M51
CO182: Procedure modifier was invalid on the date of service.
M51: Missing/incomplete/invalid procedure code(s).
N657: This should be billed with the appropriate code for these services.
Total Payments for this claim: $0.00

Anyone have any info/help on this?
 
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