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December 22, 2016

New G-Codes for RN and LPN Visits in Home Health Episodes

Change Request 9736 established four new G-codes to differentiate levels of nursing services provided during a home health episode of care.  As a result, the G0163 and G0164 will be retired, effective January 1, 2017, and are being replaced with the following G-codes.

  • G0493: Valid for 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 (the change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health or hospice setting).

 

  • G0494: Valid for 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 (the change in a patient’s condition requires skilled nursing personnel to identify and evaluate the patients need for possible modification of treatment in the home health or hospice setting).
  • G0495: Valid for 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.

 

  • G0496: Valid for 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.

Final Claims Spanning 2016/2017
For home health episodes that span January 1, 2017, home health providers will submit their final claims as follows:

  • Report codes G0163 and G0164 for visits provided in 2016. 
  • Report the new codes, G0493, G0494, G0495 or G0496, for visits made in 2017. 

The G0163 and G0164 codes will not be allowed when submitted on final claims for visits made on or after January 1, 2017.

For additional information, please refer to the MM9736External PDF Medicare Learning Network Matters® article.


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