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April 27, 2023

Telehealth Home Health Services: New G-Codes – Updates

Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health (HH) claims. Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023. On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023.

The three new codes are:

  • G0320 – Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications systems
    • Report each service as a separate dated line under the appropriate revenue code for each discipline providing the service
    • Report units as one per service (not in 15 minute increments)
    • Report charges per the HHA's internal policy for determining charges

  • G0321 – Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
    • Report each service as a separate dated line under the appropriate revenue code for each discipline providing the service
    • Report units as one per service (not in 15 minute increments)
    • Report charges per the HHA's internal policy for determining charges

  • G0322 – The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)
    • Report remote patient monitoring that spans a number of days as a single line item showing the start date of monitoring and the total number of days of monitoring in the units field for the billing period
    • Report charges per the HHA's internal policy for determining charges

Additional claim submission requirements:

  • Only report the 3 G-codes on Type of Bill 032x with revenue codes 042x, 043x, 044x, 055x, 056x, and 057x.
  • Business requirement 12805.4 of Change Request Number 12805 required contractors to return to the provider (reason code 31869) claims containing telehealth codes if there is not another line item on the claim for an in-person visit with the same revenue code. CMS has determined this requirement is not needed for telehealth service reporting and in some cases it results in claims being returned in error. As of February 4, 2023, the Medicare Administrative Contractors have turned off this reason code. HHAs may re-submit any claims that were returned with reason code 31869 prior to its deactivation.

These new HCPCS codes are not considered a home visit for the purposes of:

  • Patient eligibility or payment, per section 1895(e)(1)(A) and (B) of the Social Security Act
  • Outlier unit amounts sent to the HH Pricer
  • Calculating Low Utilization Payment Adjustment (LUPA) add-on payments
  • Ensuring covered skilled visit requirements are met
  • Review of claims with unusually high numbers of covered visits
  • Total visits counts and validation of the total visits counts shown in value codes 62 and 63

Collecting data on telecommunications technology use on HH claims will allow CMS to:

  • Analyze the characteristics of patients using services provided remotely
  • Have a broader understanding of the social determinants that affect who benefits most from these services, including what barriers may potentially exist for certain subsets of patients

The HHA must document the medical record to show how the telecommunications technology helps to achieve the goals outlined on the plan of care and the plan of care must describe how such technology is tied to the patient-specific needs in the comprehensive assessment.

References:
MLN Matters Number: MM12805External PDF
Related CR Number: 12805

Medicare Claims Processing Manual, Chapter 10 – Home Health Agency Billing, Section 40.2 – HH PPS Claims; Medicare Claims Processing ManualExternal PDF

Revised 4/18/2023: Update units and charges information for codes G0320 and G0321

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