HCPCS code G0157: Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes

Obtain a list of the documentation and billing requirements needed to properly use and code for HCPCS code G0157.

## **What is HCPCS code G0157?** HCPCS code G0157, a home health billing code, covers skilled physical therapy services provided in the home, billed in 15-minute increments. These home health physical therapy or therapeutic services may include exercises, mobility training, gait re-education, balance training, and functional activity retraining. The therapy must be part of a physician-ordered home health plan of care and is typically for patients recovering from surgery, illness, or injury. The physical therapist evaluates progress and adjusts treatment as necessary to improve independence and prevent complications.

## **HCPCS code G0157 documentation requirements** Thorough documentation is crucial for billing G0157. The following information should be included in the patient's record for each visit: - **Patient assessment or evaluation**: The PTA should document the patient's current physical status, including strength, balance, and range of motion. - **Goals**: The documentation must clearly relate back to the treatment goals established in the patient's plan of care by a qualified physical therapist. - **Progress**: Notes should include objective measures of patient performance and progress in response to therapy. - **Services rendered**: The documentation should clearly reflect the services billed, including the time actively spent with the patient (e.g., exercises, manual therapy, patient education). Travel or administrative time is not billable. - **Supervision**: The documentation should show that the services were performed under the supervision of a licensed physical therapist, who is responsible for the initial assessment, plan of care, and regular reassessments.

## **G0157 billing requirements** G0157 is billed in 15-minute increments. Here are some key billing guidelines: - **Time-based**: The code is a time-based code, meaning each unit represents 15 minutes of service. - **Place of service**: This code is specifically for services delivered in a home health or hospice setting. - **Reimbursement**: Reimbursement is determined by the patient's diagnosis and the Patient-Driven Groupings Model (PDGM), which is used by Medicare to classify patients into payment groups. - **Multiple units**: A visit may include multiple units of G0157, with the number of units corresponding to the total time spent. For example, a 30-minute session would be billed with 2 units of G0157.

## **Other related codes** - **G0151**: Services performed by a qualified physical therapist in a home health or hospice setting, each 15 minutes. - **G0152**: Services performed by a qualified occupational therapist in a home health or hospice setting, each 15 minutes. - **G0158**: Services performed by a qualified occupational therapist assistant in a home health or hospice setting, each 15 minutes. - **G2168**: Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes - **G2169**: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective maintenance occupational therapy program, each 15 minutes

Frequently asked questions

No, home health services are typically provided to patients who are considered homebound, meaning they have a condition that makes it difficult for them to leave their home without assistance.

No, it’s for home health services.

No, only a qualified physical therapist can perform the initial assessment, establish the patient's goals, and develop or modify the plan of care. A PTA can then provide services under the supervision of the PT, as outlined in the established plan.