Getting paid for home health certification with G0180 and G0179

Home health certification is now a paid service for work that is already done by many physicians.

Primary care physicians usually do not get paid for the non-face-to-face care we provide, so we have to make the most of the few billable codes that actually compensate us for this work.

HCPCS (Healthcare Common Procedure Coding System) codes G0180 and G0179, which represent home health certification and recertification, are two such examples. Both are reimbursed by Medicare. 

Implementing G0180 and G0179

The covered service is reviewing and signing the CMS 485 (formerly HCFA 485) form once every 60 days. Everything else done for the home health patient during this period is covered by the care plan oversight codes. 

The certification code, G0180, is reimbursable if the patient has not received Medicare-covered home health services for at least 60 days. The service includes the following: 

• Review of initial or subsequent reports of patient status
• Review of the patient's responses to the Oasis assessment instrument
• Contact with the home health agency to ascertain the initial implementation plan of care
• Documentation in the patient's record

The recertification code, G0179, may be submitted when the physician signs a subsequent CMS certification form after a patient has received services for at least 60 days. Code G0179 may be reported only once every 60 days, except in the rare situation when a patient starts a new episode before 60 days elapse and requires a new plan of care.

Systematic documentation for G0180 and G0179

It takes a systematic effort to make sure you capture the documentation necessary to bill for these codes. When a CMS 485 form comes in, the provider needs to review the chart. If there are no changes in the care plan, then a note needs to be generated stating: “CMS form, care plan and patient's chart reviewed. Probs, meds and treatments remain accurate. Care plan is approved. 

It is very easy to set this up as a specific note/template in your CompuGroup Medical EHR—CGM APRIMA is a great example of this—and then make sure all your providers are aware of the rules and how to complete the documentation and drop in the billing codes. I am based in New York City where reimbursements are:

• G0180 $60.49
• G0179 $48.02

Need help with G180, G0179, and other coding?

As always, I am available if you have any questions. The experts of our ARIA Coding Services team is available to assist, as well.