Physician Services for Certification and Recertification of Medicare Covered Home Health Services
Effective April 1, 2012, WPS Medicare implemented a new edit monitoring physician services for certification and recertification of Medicare-covered home health services. We will deny claims that do not meet applicable criteria.
The home health agency certification code is valid when the patient begins a new episode of home health care and when the patient has not received Medicare-covered home health (HH) services for at least 60 days. The home health agency recertification code is used after a patient has received services for at least 60 days (or one certification period) when the physician is certifying the patient's continued need for home health services. The home health agency recertification code is only valid once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapse and requires a new plan of care.
- Physician certification home health patient for Medicare covered home health service under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patients' needs, per certification period. Use G0180 to bill physician services for initial certification of Medicare-covered HH services.
- Physician recertification home health patient for Medicare covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patients' needs, per recertification period. Use G0179 to bill physician services for recertification of Medicare-covered HH services.
Enter "1" as the number of services in Item 24 of the CMS-1500 claim form or, if submitting electronically, in the ANSI format: 2400/SV104 (UN qualifier).
Note: Instructions apply to paper claims using the Form CMS-1500 and electronic claims using the 5010 version.
- The place of service code should represent the place where the majority of the plan development and review work was performed.
- The date of service is the date the service was performed, i.e., the date the plan was signed. A span of dates is not appropriate.
- No other services may be billed on the same claim as the physician services for certification or recertification.
For additional information or instructions of physician certification and recertification, see:
Change Request 9119, Manual Updates to clarify requirements for Physician Certification and recertification of Patient Eligibility for Home Health Services effective January 1, 2015:
Medicare General Information, Eligibility and Entitlement Manual, IOM Publication 100-01, Chapter 4, Sections 10-60.
Medicare Benefit Policy Manual, IOM Publication 100-02, Chapter 7, Section 30.
Medicare Claims Processing Manual, IOM Publication 100-04, Chapter 12, Section 180 - Care Plan Oversight Services.
Information is also available from the CMS Home Health Agency Center.