HCPCS code G0179: Physician or allowed practitioner re-certification for Medicare-covered home health services (patient not present)

Better understand how to properly use and bill for HCPCS code G0179 with our short guide that has a list of the code's documentation and billing requirements.

Use Code

## **What is HCPCS code G0179?** HCPCS code G0179 is a code with a description "Physician or allowed practitioner re-certification 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 and allowed practitioners to affirm the initial implementation of the plan of care". The aforementioned code is used to bill for a physician's or non-physician practitioner's work in recertifying a patient for home health care. This recertification is required to ensure the patient continues to meet the criteria for Medicare-covered home health services after the initial 60-day certification period. The clinician reviews patient records, communicates with the home health agency, and affirms that the plan of care remains appropriate and medically necessary. The visit need not include direct patient contact but does require meaningful evaluation of status reports and implementation.

## **G0179 documentation requirements** To bill for G0179, the provider's medical record must contain specific documentation to support the service. The medical record should clearly show that the physician or NPP: - Reviewed the patient status reports - Reviewed and signed the recertification for the home health plan of care (must indicate the date physician signed the certification) - Documented the clinical findings that support the continued need for home health services. - Confirmed that the patient has a plan of care established and periodically reviewed by a physician - Documented that the patient is under the care of a physician

## **G0179 billing requirements** For accurate reimbursements, the billing requirements is as follows: - Only one G0179 may be billed per certification period per patient. - The claim should reflect the provider’s NPI, office location, and date of certification. Note that this code cannot be billed for patients in a skilled nursing facility, nursing home facilities, or a hospital.

## **Other relevant codes** - G0180: Initial certification of physician for home health services, face-to-face encounter - G0181: Physician supervision of home health care requiring complex, multidisciplinary care - G0182: Medicare covered hospice care supervision

Frequently asked questions

G0180 is for the initial home health certification, while G0179 is for recertification.

Yes, you can bill for other evaluation and management (E/M) services in the same month you bill for G0179, as long as the documentation supports the E/M service and it is separate from the work included in the recertification.

In a rare situation where a patient starts a new episode and a new plan of care is required before the 60-day period for the previous episode is over, you can report G0179.