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December 29, 2022

Telehealth Home Health Services: New G-Codes

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 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
  • 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
  • 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

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.
  • Claims will be returned containing HCPCS codes G0320, G0321 and G0322 if there is not another line item on the claim with the same revenue code and a G HCPCS code other than G0320, G0321 and G0322.
    • Example: A claim with a line reporting revenue code 0551 and G0320 must also have a revenue code 055x line containing HCPCS G0299, G0300, G0162, G0493, G0494, G0495, or G0496.

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:

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