(Medicare Claims Processing Manual)

0274  Prosthetic/Orthotic Devices   Required detail: The applicable HCPCS code for the item, a date of service, a number of service units, and a charge amount. 029x  Durable Medical Equipment (DME) (Other Than Renal)   Required detail:  The applicable HCPCS code for the item, a date of service indicating the purchase date or the beginning date of a monthly rental, a number of service units, and a charge amount.  Monthly rental items should be reported with a separate lin e for each months rental and service units of one.  Revenue code 0294 is used to bill drugs/supplies for the effective use of DME.  060x  Oxygen (Home Health)   Required detail:  The applicable HCPCS code for the item, a date of service, a number of service units, and a charge amount.  Revenue Code for Optional Reporting of Wound Care Supplies   0623  Medical/Surgical Supplies - Extension of 027x   Required detail:  Only service units and a charge must be reported with this revenue code.  If also reporting revenue code 027x to identify nonroutine supplies other than those used for wound care, the HHA must ensure that the charge amounts for the two re venue code lines are mutually exclusive.   HHAs may voluntarily report a separate revenue code line for charges for nonroutine wound care supplies, using revenue code 0623.  Notwithstanding the standard abbreviation surg dressings, HHAs use this code to report charges for ALL nonroutine wound car e supplies, including but not limited to surgical dressings.   Pub. 100- 02, Medicare Benefit Policy Manual, chapter 7, defines routine vs. nonroutine supplies.  HHAs use that definition to determine whether any wound care supply item should be reported in this line because it is nonroutine.  HHAs can assist Medicares future refinement of payment rates if they consistently and accurately report their charges for nonroutine wound care supplies under revenue center code 0623.  HHAs should ensure that charges reported under revenue code 027x for nonroutine supplies are also complete and accurate.  HCPCS/Accommodation Rates/HIPPS Rate Codes   Required -  On the 0023 revenue code line, the HHA may submit the HIPPS code they expect will be used for payment if they choose to run grouping software at their site for internal accounting purposes. If not, they may submit any valid HIPPS code in order to meet this requirement.   HHAs enter only one HIPPS code per claim in all cases.  Claims submitted with additional HIPPS codes will be returned to the provider.  Medicare will determine the appropriate HIPPS code for payment based on claims and OASIS data and will replace the provider -submitted HIPPS code as necessary.  If the HIPPS code further changes based on medical review or other processes, the code used for payment is recorded in the APC -HIPPS field of the electronic claim record.   For revenue code lines other than 0023, the HHA reports HCPCS codes as appropriate to that revenue code.  The G - and Q - HCPCS codes listed below are for use by HHAs on Type of Bill 032x only.  Claims with these HCPCS codes will be returned to the provider if submitted with Type of Bill 034x.   To report HH visits, the HHA reports one of the following HCPCS codes to represent a visit by each HH care discipline:   Physical Therapy (revenue code 042x)   G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes.   G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes.  G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes.  G2168 Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes.   Occupational Therapy (revenue code 043x)   G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes.  G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes.   G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes.  G2169  Services  performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes.   Speech -Language Pathology (revenue code 044x)   G0153 Services performed by a qualified speech -language pathologist in the home health or hospice setting, each 15 minutes.  G0161 Services performed by a qualified speech -language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech- language pathology maintenance program, each 15 minutes.   Note that modifiers indicating services delivered under a therapy plan of care (modifiers GN, GO or GP) are not required on HH PPS claims.  Skilled Nursing (revenue code 055x)   General skilled nursing:   G0299  Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting  G0300  Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting.  Care plan oversight:   G0162 Skilled services by a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes (the patients underlying condition or complication requires an RN to ensure that essential non- skilled care achieves its purpose in the home health o r hospice setting).  G0493 Skilled services of a registered nurse (RN) for the observation and assessment of the patients condition, each 15 minutes (the change in the patients condition requires skilled nursing personnel to identify and evaluate the patients need for possi ble modification of treatment in the home health or hospice setting).  G0494 Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patients condition, each 15 minutes (the change in the patients condition requires skilled nursing personnel to identify and evaluate the patients need for possible modification of treatment in the home health or hospice setting).   Training:   G0495 Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.  G0496 Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.   Medical Social Services (revenue code 056x)   G0155 Services of a clinical social worker under a home health plan of care, each 15 minutes.   Home Health Aide (revenue code 057x)   G0156 Services of a home health aide under a home health plan of care, each 15 minutes.  Regarding all skilled nursing and skilled therapy visits   In the course of a single visit, a nurse or qualified therapist may provide more than one of the nursing or therapy services reflected in the codes above.  HHAs must not report more than one G -code for each visit regardless of the variety of services provi ded during the visit.  In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G -code which reflects the service for which the clinician spent most of his/her time.   For instance, if direct skilled nursing services are provided, and the nurse also provides training/education of a patient or family member during that same visit, Medicare would expect the HHA to report the G -code which reflects the service for which most  of the time was spent during that visit.  Similarly, if a qualified therapist is performing a therapy service and also establishes a maintenance program during the same visit, the HHA should report the G -code that reflects the service for which most of the time was spent during that visit.  In all cases, however, the number of 15- minute increments reported for the visit should reflect the total time of the visit.   Telehealth Service Reporting   Beginning on or after January 1, 2023, HHAs may voluntarily report the use of telecommunications technology in the provision of home health services on claims. This information is required on home health claims beginning on July 1, 2023. HHAs shall submit the use of telecommunications technology when furnishing home health services, on the home health claim via three G -codes.   G0320: home health services furnished using synchronous telemedicine rendered via a real-time two -way audio and video telecommunications system   G0321: home health services furnished using synchronous telemedicine rendered via telephone or other real -time interactive audio -only telecommunications system  G0322: the collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring).   HHAs shall submit services furnished via telecommunications technology in line item detail and each service must be reported as a separately dated line under the appropriate revenue code for each discipline furnishing the service.  Two occurrences of G0320 or G0321 on the same day for the same revenue code shall be reported as separate line items.   The use of remote patient monitoring that spans a number of days shall be reported as a single G0322 line item reporting the beginning date of monitoring and the number of days of monitoring in the units field.   If more than one discipline is using the re mote monitoring information during the billing period, the HHA may choose which revenue code to report on the remote monitoring line item.   Claims with no billable visits are not submitted to Mediare, including claims for billing periods where only telehealth services are provided.   Site of Service Reporting   HHAs must report where home health services were provided.  The following codes are used for this reporting:   Q5001: Hospice or home health care provided in patients home/residence   Q5002: Hospice or home health care provided in assisted living facility   Q5009: Hospice or home health care provided in place not otherwise specified  The location where services were provided must always be reported along with the first visit reported on the claim.  In addition to reporting a visit line using the G codes as described above, HHAs must report an additional line item with the same revenue code and date of service, reporting one of the three Q codes (Q5001, Q5002, and Q5009), one unit and a nominal covered charge (e.g., a penny).  If the location where services were provided changes during the period of care, the new location should be repor ted with an additional line corresponding to the first visit provided in the new location.   Disposable Negative Pressure Wound Therapy Services   Effective for claims with statement covers Through dates on or after January 1, 2024, Medicare makes a separate payment amount for a disposable negative pressure wound therapy (NPWT) device for a patient under a home health plan of care.  Payment is equal to the supply price used to determine the relative value for the service under the Medicare Physician Fee Schedule (as of January 1, 2022) for the applicable disposable device and updated by the consumer price index for all urban consumers minus the produc tivity adjustment for each future year.   Disposable NPWT services are billed using the following HCPCS code:     A9272 -  wound suction, disposable, includes dressing, all accessories and components, any type, each.    The HHA reports the HCPCS code with revenue code 027x (other than 0274), units representing the number of disposable devices provided during the billing period and a charge amount.  Since Medicare payment no longer includes the services of the practitioner  applying the device, revenue codes 042x, 043x or 0559 are not used for dNPWT HCPCS codes on Type of Bill 032x.   Modifiers   If the NOA that corresponds to a claim was filed late and the HHA is requesting an exception to the late -filing penalty (see section 10.1.10.3), append modifier KX to the HIPPS code reported on the revenue code 0023 line.    Service Date   Required -  For initial periods of care, the HHA reports on the 0023 revenue code line the date of the first covered visit provided during the period.  Claims and provider -submitted adjustments where the Admission Date and From Date match but the 0023 revenue code line date does not also match are returned to the provider.  Contractor -submitted adjustments are excluded from this edit.    For subsequent periods, the HHA reports on the 0023 revenue code the date of the first visit provided during the period, regardless of whether the visit was covered or non-covered.   For other line items detailing all services within the period, the HHA reports service dates as appropriate to that revenue code.  For service visits that begin in 1 calendar day and span into the next calendar day, report one visit using the date the visi t ended as the service date.   When the claim Admission Date matches the Statement Covers From Date, Medicare systems ensure that the Service Date on the 0023 revenue code line also matches these dates.   Service Units