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Physician Certification and Recertification of Medicare-covered Home Health Services

Physician services involving physician certification (and recertification) of Medicare-covered home health services may be separately coded and reimbursed. These services include creation and review of a plan of care, and verification that the home health agency initially complies with the physician’s plan of care. The physician’s work in reviewing data collected in the home health agency’s (HHAs) patient assessment would be included in these services.

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HCPCs for Home Health Services 

  • G0179 - Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per re-certification period
  • G0180 - Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period 

Note: G0179 and G0180 are not included in the global surgical package and therefore, are billable and separately payable when furnished during a global period. 

Descriptions 

G0179 - Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per re-certification period 

G0180 - Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period

Note: G0179 and G0180 are not included in the global surgical package and therefore, are billable and separately payable when furnished during a global period.

Eligible practitioners 

Physician services for certification/recertification are covered for reimbursement only when performed by physicians (e.g., MD’s, DO’s and DPM’s with respect to those functions which he/she is legally authorized to perform per State regulations). 

Claims for services will be denied if the physician submitting the claim is not the physician signing the HHA plan of care (the primary physician). 

Only one physician may bill for services for certification of Medicare-covered HHA services for a beneficiary, in a 60-day period. All other claims will be denied.

Insights
December 2018