February 27, 2017 - Updated 04.03.19
Valid/Invalid G-Codes for Home Health and Hospice
CGS has seen providers continuing to submit G-codes that are not valid for the dates of services being billed. Please review the following list of valid and invalid codes with your billing staff to ensure the appropriate code is submitted. The validity of the HCPCS codes is based on the date services were provided.
Home Health Invalid HCPCS Codes
HCPCS Code |
Invalid For Dates of Service |
Description |
G0154 |
Services provided on or after January 1, 2016 |
Direct skilled services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes. |
G0162 |
Services provided on or after January 1, 2017 |
Skilled services of a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes. |
G0163 |
Services provided on or after January 1, 2017 |
Skilled services of a licensed nurse (LPN or RN) for the observation and assessment of the patient's condition, each 15 minutes. |
G0164 |
Services provided on or after January 1, 2017 |
Skilled services of a licensed nurse (LPN or RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes. |
Home Health Valid HCPCS Codes
HCPCS Code |
Valid For Dates of Service |
Description |
G0299 |
Services provided on or after January 1, 2016 |
Direct skilled nursing services of a registered nurse (RN) in home health or hospice setting, each 15 minutes. |
G0300 |
Services provided on or after January 1, 2016 |
Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes. |
G0493 |
Services provided on or after January 1, 2017 |
Skilled services of a registered nurse (RN) for the observation and assessment of the patient's condition, each 15 minutes. NOTE: Only valid for home health providers. |
G0494 |
Services provided on or after January 1, 2017 |
Skilled services of a licensed practical nurse (LPN) for the observation and assessment of a patient's condition, each 15 minutes. NOTE: Only valid for home health providers. |
G0495 |
Services provided on or after January 1, 2017 |
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. NOTE: Only valid for home health providers. |
G0496 |
Services provided on or after January 1, 2017 |
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. NOTE: Only valid for home health providers. |
For home health episodes that span 2015/2016 or 2016/2017, report the appropriate G-code on the detail line based on the date of service.
Hospice Invalid HCPCS Codes
HCPCS Code |
Invalid For Dates of Service |
Description |
G0154 |
Services provided on or after January 1, 2016 |
Direct skilled services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes. |
Hospice Valid HCPCS Codes
HCPCS Code |
Valid For Dates of Service |
Description |
G0299 |
Services provided on or after January 1, 2016 |
Direct skilled nursing services of a registered nurse (RN) in home health or hospice setting, each 15 minutes. |
G0300 |
Services provided on or after January 1, 2016 |
Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes. |
Resources:
- CMS Pub 100-04, Ch. 10, Section 40.2 – HH PPS Claims
- MM9736
, Implementation of Policy Changes for the CY 2017 Home Health Prospective Payment
- MM9369
, Additional G-Codes Differentiating RNs and LPNs in the Home Health and Hospice Settings