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April 12, 2016

Reminder: Code G0154 Not Valid for January 2016 Dates of Service

Change Request (CR) 9369 established two new G-codes, G0299 and G0300 to differentiate levels of nursing services provided during a hospice stay and a home health episode of care. This CR also announced that G0154 is no longer valid for nursing visits (revenue code 055X) made on or after January 1, 2016.

When G0154 is reported with revenue code 055X for services on or after January 1, 2016, the claim will go to the return to provider (RTP) file with reason code 32403 for home health and 32402 for hospice claims indicating that this code is not valid for the dates of service. Providers need to correct their claim by applying one of the appropriate codes listed below. If your claim is in RTP and shows the correct G codes, press F9 to continue processing.

  • G0299 – services of a registered nurse
  • G0300 – services of a licensed practical nurse

For home health episodes that span January 1, 2016, report G0154 for 2015 visits. The new codes, G0299 or G0300, would be reported for visits made in 2016.

Please note that all other skilled nursing codes are still valid to use as appropriate. Please refer to the following CGS resources for guidance when billing home health and hospice claims.

For additional information, please refer to the MM9369External PDF Medicare Learning Network Matters® article on the CMS website.

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