Telehealth Home Health Services: New G-Codes

Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health (HH) claims. Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023. On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023. 

Three New Codes

• G0320 — Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications systems
  • Report each service as a separate dated line under the appropriate revenue code for each discipline providing the service
  • Report units as one per service (not in 15-minute increments)
  • Report charges per the HHA’s internal policy for determining charges
• G0321 — Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
  • Report each service as a separate dated line under the appropriate revenue code for each discipline providing the service
  • Report units as one per service (not in 15 minute increments)
  • Report charges per the HHA’s internal policy for determining charges
• G0322 — The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)
  • Report remote patient monitoring that spans a number of days as a single line item showing the start date of monitoring and the total number of days of monitoring in the units field for the billing period
  • Report charges per the HHA’s internal policy for determining charges
  • If more than one discipline is using the remote monitoring information during the billing period, the HHA may choose which revenue code to report on the remote monitoring line item

Additional Claim Submission Requirements

• Only report the 3 G-codes on Type of Bill 032x with revenue codes 042x, 043x, 044x, 055x, 056x and 057x 
• Do not submit a telehealth service date as the location code (Q5001, Q5002 or Q5009) claim line item date. Only an in person visit date may be reported with the location code, or the claim will return with reason code 31791.
• The HHA should not submit a claim if only telehealth services and no in-person visits were provided in the billing period.  

These new HCPCS codes are not considered a home visit for the purposes of:

• Patient eligibility or payment, per section 1895(e)(1)(A) and (B) of the Social Security Act
• Outlier unit amounts sent to the HH Pricer
• Calculating Low Utilization Payment Adjustment (LUPA) add-on payments
• Ensuring covered skilled visit requirements are met
• Review of claims with unusually high numbers of covered visits
• Total visits counts and validation of the total visits counts shown in value codes 62 and 63

Collecting data on telecommunications technology use on HH claims will allow CMS to: 

• Analyze the characteristics of patients using services provided remotely 
• Have a broader understanding of the social determinants that affect who benefits most from these services, including what barriers may potentially exist for certain subsets of patients

The HHA must document the medical record to show how the telecommunications technology helps to achieve the goals outlined on the plan of care and the plan of care must describe how such technology is tied to the patient-specific needs in the comprehensive assessment.

References

• MLN Matters Number: MM12805 (PDF)
• MLN Matters Number: MM13110 (PDF)
• Related CR Number: 12805 (PDF)
• Medicare Claims Processing Manual, Chapter 10 - Home Health Agency Billing, Section 40.2 - HH PPS Claims (cms.gov)