CMS Issues G-Codes to Differentiate RN and LPN visits for Hospice, Home Health

From NAHC: Different Codes for RN/LPN Visits will Facilitate Implementation of Hospice Payment Reforms

On Friday, October 16, 2015, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 3378/Change Request 9369, providing Additional G-Codes Differentiating Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in the Home Health and Hospice Settings. The issuance of these two new codes, G0299 for RNs and G0300 for LPNs, was necessary so that, beginning with hospice services provided on or after January 1, 2016, CMS can appropriately pay hospices for RN visits during the last seven (7) days of life in the Routine Home Care (RHC) setting when those visits are eligible for the Service-Intensity Add-on (SIA). These two G-codes will be applicable effective for hospice dates of services on and after January 1, 2016, and for home health episodes of care ending on or after January 1, 2016; with the institution of the new codes the existing “G0154 — Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting” will be retired.

CR 9369 modifies the hospice chapter of the Medicare Claims Processing Manual to require use of the two new G-codes (with retirement of G-0154) and to correct the existing example for the two-tiered RHC payment system as the example issued as part of CR 9201 was incorrect relative to the day counts (it did not take into consideration that 2016 is a leap year). CR9369 also provides additional claims submission detail over the example for the SIA provided in CR 9201 to reflect the newly-established G-codes. The home health chapter of the Medicare Claims Processing Manual has been modified as part of CR 9369 to reflect the addition of the two new G-codes and retirement of G-0154.

Use of the new G-codes will be required for both home health and hospice under Medicare and may be applicable to Medicaid and other payer claims where reporting of nursing visits is required.  As the National Association for Home Care & Hospice (NAHC) has reported previously, many states at this time do not require hospices to report visits on claims, which will be necessary in order for the Medicaid programs to implement the SIA payment mechanism.

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