Results 1 to 4 of 4

Need Medicaid Home Health Care CPT Codes

  1. Question Need Medicaid Home Health Care CPT Codes
    Medical Coding Books
    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

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    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.
    Last edited by RebeccaWoodward*; 11-06-2009 at 06:41 AM.

  3. Question 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

  4. Default 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?

Similar Threads

  1. Home Health Care
    By botts44 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-28-2011, 10:13 AM
  2. Home Health Care
    By arparkins in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 05-12-2010, 07:19 AM
  3. Need Home health Care CPTs Medicaid- Help
    By neha.bhatnagar in forum E/M
    Replies: 3
    Last Post: 11-09-2009, 06:03 AM
  4. home health billing - medicaid (florida)
    By pausuga in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-11-2008, 07:42 AM
  5. Home Health Care
    By feldbusch in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-22-2007, 09:03 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.