CMS Introduces Four New G-Codes for Home Health

The Centers for Medicare & Medicaid Services (CMS) is introducing four new home health G-codes to replace two old ones—and this worries officials at the National Association for Home Care & Hospice (NAHC), who fear providers may not have adequate time to prepare for the changes.

CMS recently issued Change Request 9736, which applies new payment policies to home health agencies starting on Jan. 1, 2017. Specifically, the Change Request (CR) details payment policies for disposable Negative Pressure Wound Therapy (dNPWT) devices and outlier payments utilizing the new methodology, which involves changes in reporting non-covered charges. Additionally, the CR includes the updates for the PRICER logic for 2017 home health prospective payment system (HHPPS), NAHC said on its website.

The CR also requires agencies to start reporting four new G-codes associated with home visits from licensed practical nurses (LPNs) and registered nurses (RNs).

Specifically, CMS has proposed that two G-codes—G0164 and G0163—be swapped out for four new G-codes, effected Jan. 1, 2017. The four new codes are, according to NAHC:

  • G0494 Skilled services of an LPN for the assessment and observation 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 potential modification of treatment in the hospice  or home health setting).
  • G0496 Skilled services of an LPN, in the education and/or training of a patient or family member, in the home health or hospice setting, each 15 minutes.
  • G0495 Skilled services of an RN in the education and/or training of a patient or family member, in the home health or hospice setting, each 15 minutes.
  • G0493 Skilled services of an RN for the assessment and observation 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 potential modification of treatment in the hospice or home health setting).

The short notice CMS has given providers to implement the new G-codes is concerning, NAHC said on its website. CMS also failed to mention in the HHPPS final rule that it intended to require four new G codes associated with skilled nursing services, NAHC said, adding that it is seeking feedback from its members on whether vendors and providers will be prepared to implement the changes by Jan. 1, 2017.

Written by Mary Kate Nelson

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