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Billing for care plan oversight

  1. Question Billing for care plan oversight
    Medical Coding Books
    I feel like I am getting conflicting information on billing for G0180. Is there a time component involved in the primary certification?

  2. #2
    Tacoma, WA
    Quote Originally Posted by laharp4 View Post
    I feel like I am getting conflicting information on billing for G0180. Is there a time component involved in the primary certification?
    Here are the Medicare CPO billing requirements.

    Pub 100-4,12,180.1
    Care Plan Oversight Billing Requirements
    A. Codes for Which Separate Payment May Be Made Effective January 1, 1995, separate payment may be made for CPO oversight services for 30 minutes or more if the requirements specified in the Medicare Benefits Policy Manual, Chapter 15 are met.
    Providers billing for CPO must submit the claim with no other services billed on that claim and may bill only after the end of the month in which the CPO services were rendered. CPO services may not be billed across calendar months and should be submitted (and paid) only for one unit of service.
    Physicians may bill and be paid separately for CPO services only if all the criteria in the Medicare Benefit Policy Manual, Chapter 15 are met.
    B. Physician Certification and Recertification of Home Health Plans of Care Effective 2001, two new HCPCS codes for the certification and recertification and development of plans of care for Medicare-covered home health services were created.
    See the Medicare General Information, Eligibility, and Entitlement Manual, Pub. 100-01, Chapter 4, "Physician Certification and Recertification of Services," 10-60, and the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 7, "Home Health Services", 30.
    The home health agency certification code can be billed only when the patient has not received Medicare-covered home health services for at least 60 days. The home health agency recertification code is used after a patient has received services for at least 60 days (or one certification period) when the physician signs the certification after the initial certification period. The home health agency recertification code will be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapses and requires a new plan of care to start a new episode.
    C. Provider Number of Home Health Agency (HHA) or Hospice For claims for CPO submitted on or after January 1, 1997, physicians must enter on the Medicare claim form the 6-character Medicare provider number of the HHA or hospice providing Medicare-covered services to the beneficiary for the period during which CPO services was furnished and for which the physician signed the plan of care. Physicians are responsible for obtaining the HHA or hospice Medicare provider numbers.
    Additionally, physicians should provide their UPIN to the HHA or hospice furnishing services to their patient.
    NOTE: There is currently no place on the HIPAA standard ASC X12N 837 professional format to specifically include the HHA or hospice provider number required for a care plan oversight claim. For this reason, the requirement to include the HHA or hospice provider number on a care plan oversight claim is temporarily waived until a new version of this electronic standard format is adopted under HIPAA and includes a place to provide the HHA and hospice provider numbers for care plan oversight claims.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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