A. DEFINITIONS

1. GO180 Physician services for initial certification of Medicare-covered Home Health services, billable once, for a patient’s home health certification period. This code will be used when the patient has not received Medicare-Covered home health service for at least 60 days.

2. GO179 Physician services for re-certification of Medicare covered Home Health services, billable after a patient’s home health certification period. This code would be used after a patient has received services for 60 days or one certification period, and the physician signs the certification (plan of care) for the 2nd time to begin another 60 day episode of care.

B. CONDITIONS FOR PAYMENT

A physician who has a significant financial interest in, or a significant financial or contractual relationship with a home health agency, generally cannot bill this code for patients served by that Home Health agency. The physician has furnished a service requiring a face-to-face encounter with the patient in the 6 months before the first billing. The services are furnished to beneficiaries receiving Medicare covered home health.

C. DOCUMENTATION

Physicians need to keep a copy of the Home Health Care Plan Certification (CMS-485) and any interim orders in the patients file.

D. BENEFICIARY CO-PAYMENT

Services provided by physicians under Medicare Part B, the Medicare beneficiary is responsible for a 20% co-payment. Supplement insurance or Medicaid may cover the coinsurance amount.

E. REIMBURSEMENT RATE

Contact Kare-In-Home for more information or staff education on the specifics for Certification/Recertification billing.