Agencies
Services
Provider Notice issued 05/03/16
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.
Home Health Agencies Handbook and Appendix Re-issue Including Prior Approval and Billing Changes for Home Health Nursing and Personal Care Services Effective January 1, 2016
To: Enrolled Home Health Agencies
Date: May 3, 2016
Re: Home Health Agencies Handbook and Appendix Re-issue Including Prior Approval and Billing Changes for Home Health Nursing and Personal Care Services Effective January 1, 2016
The Department is reissuing the Chapter R-200, Handbook for Home Health Agencies. Changes include the Department’s prior approval and billing policies for in-home shift (hourly) nursing and personal care services, as well as provider enrollment instructions. These changes are effective with dates of service on and after January 1, 2016.
Coding Changes
On January 1, 2016, HCPCS G0154 became obsolete and was replaced with two codes:
The code for Certified Nurse Aide (CNA) remains G0156.
Prior Approval Changes
Effective January 1, 2016, the Department changed its method of approving the timeframes and units for nursing services. The prior approval letter reflects the information needed to bill and be reimbursed. The prior approval letters issued for in-home shift nursing services for codes G0299, G0300, and G0156 contain a “Quantity” field that represents the total number of approved hours for the specified timeframe listed and a “Unit Amount/Total Amt.” field that represents the approved hourly rate.
Prior to January 1, 2016, the prior approval Quantity field represented the total number of weeks approved and the “Unit Amount/Total Amt.” field represented the weekly maximum reimbursement amount allowed for the week.
Billing Changes
Effective with dates of service January 1, 2016, claims for G0299, G0300 and G0156 must be submitted for each date of service. The total number of service hours per date of service should be reported in the Units/Quantity field. The Provider Charge/Line Item Charge Amount is the approved hourly rate multiplied by the number of hours for that day of service.
If less than an hour of service is provided, the Unit field should be rounded up to the next hour, and the charge amount should be reduced to reflect the actual time according to the chart below.
Service Time |
Charge Amount |
Less than 8 minutes |
Not billable |
9 – 22 minutes |
¼ of the hourly rate |
23 – 37 minutes |
½ of the hourly rate |
38 – 52 minutes |
¾ of the hourly rate |
53 – 60 minutes |
Full hourly rate |
Prior to January 1, 2016, claims were submitted at the end of each work week, reporting the total charges for the week for the services and a Unit/Quantity of “1”.
Providers who billed charges for dates of service January 1, 2016 and after may have received incorrect payments if the Unit/Quantity field was “1”. Providers must submit an 837P claim using Claim Frequency “7” to replace the paid claim. Replacement claims may be submitted electronically by MEDI direct data entry (DDE), selecting the Professional-Provider Invoice claim submission. Void and Replacement of a Claim/Service Line instruction can found in the Chapter 300, 837P Companion Guide (pdf).
Provider Enrollment Changes
Provider Enrollment in Section R-201 has been updated to reflect changes made to the enrollment process under IMPACT, the Department’s new web-based enrollment system.
Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Felicia F. Norwood
Director