- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Notice of Admission Questions and Answers
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Periods with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- 30-Day Home Health Therapy Reassessment Schedule
Billing G-Codes for Therapy and Skilled Nursing Services
Table of Contents
- Billing G-Codes for Therapy and Skilled Nursing Services
- What You Need to Know to Bill
- Related Content
Billing G-Codes for Therapy and Skilled Nursing Services
HHAs are required to report specific data about therapy and nursing visits on home health period of care claims.
The requirements include G-codes for:
- Physical Therapy (revenue code 042x)
- Occupational Therapy (revenue code 043x)
- Speech-Language Pathology (revenue code 044x)
- Skilled Nursing (revenue code 055x)
What You Need to Know to Bill
Physical Therapy
- G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
- G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
- G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, 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
Occupational Therapy
- G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
- G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
- G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational 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 occupational therapy maintenance program, each 15 minutes
Speech Language Pathology
- G0153 Services performed by a qualified speech language pathologist in the home health or hospice setting, each 15 minutes
- G0161 Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech language pathology maintenance program, each 15 minutes
Note that modifiers indicating services delivered under a therapy plan of care (modifiers GN, GO or GP) are not required on HH PPS claims.
Skilled Nursing
General Skilled Nursing
- G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting.
- G0300 Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting.
Care Plan Oversight
- G0162 Skilled services by a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes (the patient’s underlying condition or complication requires an RN to ensure that essential nonskilled care achieves its purpose in the home health or hospice setting).
- G0493 Skilled services of an RN for the observation and assessment 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 possible modification of treatment in the home health or hospice setting).
- G0494 Skilled services of an LPN for the observation and assessment 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 possible modification of treatment in the home health or hospice setting).
Training
- G0495 Skilled services of an RN, in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.
- G0496 Skilled services of an LPN, in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.
Note: Only one G-code should be used per visit. CMS recognizes in the course of a visit, a nurse or qualified therapist could likely provide more than one of the nursing or therapy services reflected in the codes above. However, HHAs must not report more than one G-code for the nursing visit regardless of the variety of nursing services provided during the visit. Similarly, the HHA must not report more than one G-code for the therapy visit, regardless of the variety of therapy services provided during the visit. In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G-code which reflects the primary reason for the visit, which typically would be the service which the clinician spent most of his/her time.
Related Content
- Change Request 9369
- Change Request 7182
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 10, Section 40.2
Revised 5/23/2024