CMS’s New Home Health Claims Reporting Requirements for G Codes Therapy and Skilled Nursing Services

Good Morning MFS Bloggers,

The January 1, 2011 effective date means that these new and revised G-codes should be used for home health episodes beginning on or after January 1st, 2011.

CMS’s new requirements include:

– The revision of the current descriptions for the G-codes for physical therapists (G0151), occupational therapist (G0152), and speech-language pathologists (G0153), to include that they are to be used to report services that are provided by a qualified physical or occupational therapist, or speech language pathologist;

– The addition of two new G-codes (G0157 and G0158) to report restorative physical therapy and occupational therapy provided by qualified therapy assistants;

– The addition of three new G-codes (G0159, G0160 and G0161, physical therapist, occupational therapist, and speech language pathologists, respectively) to report the establishment, or delivery of therapy maintenance programs by qualified therapists;

– The revision of the current G-code definition for skilled nursing services (G0154) and the requirement that HHAs use this code only for the reporting of direct skilled nursing care to the patient by a licensed nurse (LPN or RN); and,

– The addition of three new G-codes (G0162, G0163, and G0164) that are required to report: 1) the skilled services of a licensed nurse (RN only) in the management and evaluation of the care plan; 2) the observation and assessment of a patient’s conditions when only the specialized skills of a licensed nurse (LPN or RN) can determine the patient’s status until the treatment regimen is essentially stabilized; and 3) the skilled services of a licensed nurse (LPM or RN) in the training or education of a patient, a patient’s family member, or caregiver.

** More information regarding the new G codes can be found in CMS’s Change
Request 7182.

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