Frequently Asked Questions – G Codes

Peninsula Home Care - Physicians - G CodesQ. What is the difference between Care Plan Oversight (CPO) reimbursement and reimbursement for Certification and Recertification of Home Health Orders?

A. CPO – If a physician spends 30 minutes or more in a calendar month supervising and monitoring a patient’s Plan of Care, including, but not limited to reviewing charts, reports or Plans of Care and telephone conferences with other health professionals involved in the Plan of Care, the physician may bill for CPO under codes G0181 or G0182. To bill for CPO, the physician must document time spent on Medicare reimbursable activities for that patient in a calendar month.

Cert and Recert – If a physician reviews and signs initial certification for Medicare-covered Home Health services, the physician can bill under code G0180. Physicians may only bill for code G0810 once during a patient’s Home Health certification period. Under code G0179, a physician may bill for signing recertification orders for Home Health services after the initial 60-day certification period is up. Under rate circumstances, if a patient begins a new episode before the 60-day certification period has expired and a new Plan of Care is required, a physician may bill under code G0179. Physicians are not required to document time spent under codes G0179 and G0180 as required by CPO.

Q. How do I bill for Cert and Resert?

A. Utilize Form 1500 using the appropriate G-Code (G0180 or G0179), the date, the charge and the Home Health provider number. HCFA also recommends including a copy of the patient’s form 485 when submitting a claim. A copy of the patient’s 485 must also be kept in the physician’s office.

Q. Can I bill for Home Health verbal orders?

A. No, you can’t bill for verbal orders. Time spent reviewing and signing verbal orders is included in the Cert & Recert.

Q. Can rural health clinic physicians bill for Cert and Recert?

A. No. Medicare pays the rural health clinic for their services provided to Medicare patients.

Q. Can a surgeon bill for Cert & Recert?

A. Yes, if they are the active physician who has referred the patient for Medicare covered Home Health services and who is Certifying or re-certifying the Plan of Care.

Q. How often does a physician have to have a face-to-face visit with a patient to be reimbursed for Cert & Recert?

A. A physician is required to have seen the patient in the six-month period prior to certification of Medicare-approved Home Health Services.

Q. When can I bill for Cert & Recert?

A. You may bill for codes G0179 and G0180 immediately following reviewing and signing a Cert or Recert of patient’s Plan of Care. However, if a patient is readmitted to Home Health with a different Plan of Care during the same month as the original Cert or Recert, the physician can only bill once during that month.

Q. under the Medicare conditions of participation, am I required to bill the patient a 20% co-pay?

A. Yes, the patient must be billed for the co-pay and a “reasonable” effort must be made to collect.

For more information on Medicare billing, contact your local Home Health Agency or your state’s Medicare office.

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