Originally published March 20, 2020. Payer rules change; confirm current CMS and payer requirements before billing.
Physician supervision of patients under home health or hospice care is called care plan oversight (CPO). These patients receive complex care that requires ongoing physician involvement. CPO is covered only for home health and hospice patients, not for patients in a skilled nursing facility (SNF) or other nursing facility.
Requirements for home health
- The patient is confined to the home (homebound)
- The patient is under the care of a physician
- The patient requires skilled services
- The patient has an established home health plan of care (POC) that a physician reviews regularly
- A face-to-face encounter with a physician took place no more than 90 days before, or within 30 days after, the start of home health care
When a patient needs the services of a home health agency (HHA), CPO is billed with codes G0179 through G0182.
- G0179
- Physician recertification for home health care
- G0180
- Physician certification for home health care
- G0181
- Home health care supervision, at least 30 minutes per month
- G0182
- Hospice care supervision, at least 30 minutes per month
Billing details
The short description for G0179 is "MD recertification HHA PT." It can be billed once every 60 days, or once per certification period, unless the patient starts a new episode within 60 days, which is rare. G0179 includes time spent contacting the HHA and reviewing patient status reports.
The short description for G0180 is "MD certification HHA patient." G0180 is used for the initial certification when the patient has not received Medicare-covered home health services in the past 60 days. It cannot be billed with G0181 on the same date of service.
The short description for G0181 is "Home health care supervision." G0181 covers reviewing status reports, labs and other studies, communicating with other professionals involved in the patient's care, and revising or continuing the home health plan of care.
The short description for G0182 is "Hospice care supervision." G0182 covers the same work as G0181 for patients receiving hospice care.
All four codes must be billed for a period when the patient was receiving Medicare-covered home health or hospice services. For complete billing instructions, see the CMS website.
Medicaid coverage
Medicaid does not pay the physician for certifying the home health plan of care. That work is considered already paid through the evaluation and management services provided while the patient receives home health care.
Medicaid does cover the home health services provided by the agency, but not the physician's certification of the plan of care.