Can Physicians bill Medicare for Home Health Services Certification and Re-certification?

Written by: Judd Humpherys, Administrator for Capitol Home Health

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Physicians can bill Medicare for the Certification and Re-certification of home health services if they use the right diagnosis codes. This is work they are already doing, so they might as well get paid for it.

Patients who want to use Medicare Home Health benefits must go through a Certification or Re-certification process under the care of a Primary Care Physician. The Medicare Policy Manual,  Chapter 7 section 30.5.1 states:

“The home health agency must be acting upon a plan of care . . . and a physician certification or re-certification.”

The “. . .  physician must certify that the home health services are, or were, needed because the patient is, or was, confined to home . . . . The patient needs, or needed, skilled nursing services or physical therapy or speech-language pathology services on an intermittent basis.

“A plan of care has been established and is periodically reviewed by the physician (the same physician who is certifying home health services) . . . . The services are, or were, furnished while the patient is, or was, under the care of the physician (the same physician who is certifying home health services). . . and a face-to-face encounter occurred no more than 90 days prior to, or within 30 days after, the start of home health care.”

Physician Certification of Home Health plan of care (billing code G0180) is defined as “physician services for initial certification of Medicare covered home health services,” according to the Medicare website. This code can be used when a patient has not received home health services for at least the past 60 days.

Billing code G0179 can be used by a physician who re-certifies a patient’s plan of care for home health services after the initial 60 day certification period has ended, and the patient continues to need home health services, and the initial certification criteria discussed above continue to exist.

In conclusion: a physician who certifies and re-certifies their patients for Medicare covered Home Care services can bill Medicare for those certification and re-certification services.  They are already doing this work, so they might as well get paid for it.

Please contact Judd Humpherys, Administrator of Capitol Home Health, at 512-467-6900 about this or any other questions concerning Medicare covered home health services you may have.