Understanding CMS Update Related To Medicare G Codes In Home Health Services

Understanding CMS Update Related To Medicare G Codes In Home Health Services

Ever since the rise of telehealth has made home health services more accessible and convenient for patients. The use of telehealth options has undoubtedly improved reimbursements for healthcare providers, but when it comes to billing for home health services, it’s not always a walk in the park.

With the constant changes in CMS (Centers for Medicare & Medicaid Services) guidelines related to home health procedures, healthcare providers are on the lookout for the right guidance. They need assistance in navigating the complex world of billing and ensuring they use the cpt codes for home health.

it’s about securing the means for healthcare providers to deliver crucial care to patients in their homes while keeping their financial footing steady. So, let’s take a deep dive into the world of home health CPT codes

CMS Update on CPT Codes for Home Health

To be eligible for home healthcare reimbursements, it’s crucial to determine if your Home Health Agency (HHA) meets the necessary qualifications. Your practice’s ability to benefit from healthcare reimbursements hinges on understanding the scope of services offered under Medicare Parts A and B. This knowledge is vital for ensuring that your HHA is in a position to receive these reimbursements, thereby securing the financial benefits they offer.

Part A Services Eligibility Criteria in Home Health Care Medicare Reimbursement

In a significant development that took effect on January 1, 2023, the Centers for Medicare & Medicaid Services (CMS) ushered in a fresh wave of changes by introducing new Medicare G codes pertaining to remote patient monitoring (RPM) services within home health. These newly introduced cpt g codes serve a crucial informational role but came with a twist – CMS at first was not providing reimbursements for them.

However, here’s where it gets interesting: from July 1, 2023, these codes become more than just informational; they will transition into mandatory components for all home health agency (HHA) RPM programs. It’s a transformative shift that healthcare providers in the home health sector need to be aware of and adapt to as we delve into this CMS update on CPT code for home health.

Home Health G code Cheat Sheet

After the recent update by CMS, 3 new home health cpt g codes were added:

G CPT codes



Telehealth services with audio and video


Audio-only telehealth services


Remote patient monitoring

Now, let’s delve into how these gcode cheat sheet work and in which conditions they are typically used:

G0320 – Telehealth services with audio and video:

  • This code is employed when healthcare providers conduct telehealth sessions that include both audio and video components.
  • It is suitable for virtual appointments where patients and healthcare professionals can see and communicate with each other in real-time.
  • Conditions where G0320 might be used include routine check-ups, follow-up consultations, and assessments that require visual examination, such as assessing a skin condition or reviewing physical therapy exercises.

G0321 – Audio-only telehealth services:

  • G0321 is the code to use when healthcare providers engage in telehealth services that involve audio communication only, without video.
  • This code is handy for telephone consultations, where patients and providers can have discussions and provide medical advice or guidance.
  • Conditions suitable for G0321 include instances where video is not necessary, such as discussing lab results, medication adjustments, or addressing minor health concerns over the phone.

G0322 – Remote patient monitoring:

  • G0322 is designated for remote patient monitoring services, which involve the use of technology to collect and transmit patient data to healthcare providers.
  • These services typically require the use of devices like blood pressure monitors, glucose meters, or wearable sensors to track and share patient health information.
  • Remote patient monitoring is often used for chronic conditions, like diabetes or hypertension, where regular monitoring and data collection are essential for ongoing care and management.
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How to Report Remote Patient Monitoring

When it comes to reporting remote patient monitoring on your healthcare claim, there are a few simple rules to follow for accurate billing. Let’s break it down:

Starting Date for Remote Patient Monitoring:

For remote patient monitoring services, use the very first date when you began monitoring the patient’s health remotely.

The number of units should reflect the total number of days you’ve been monitoring the patient.

Date and Time for Telehealth Encounters:

When using the other two codes (for telehealth with audio and video or audio-only telehealth), report the date when the virtual encounter happened.The units should indicate the time spent in 15-minute increments during those visits.

Now, here’s the key takeaway: These telehealth services should always be a part of the patient’s care plan, prescribed by a physician, and carried out as per their instructions.

Can a Home Health Agency Submit a 30-day Claim with G Codes?

CMS (Centers for Medicare & Medicaid Services) addressed a common question in the home health industry. CMS’s response is clear: No, you should not file a 30-day claim if there are no other skilled services to report.

In essence, if a home health agency’s claim only involves these specific G-Codes and no other skilled services are provided, CMS advises against submitting such a claim. This guidance is aimed at streamlining the billing process and ensuring that claims accurately reflect the services rendered, avoiding unnecessary paperwork for both healthcare providers and CMS.

Getting Paid for Telehealth Services in Home Health

Understanding how Medicare pays for telehealth services in the home health field is essential for ensuring patients receive the care they need, and providers get compensated properly. Let’s break down how it works:

Part A Services:

  • Home Health Agencies (HHAs) can get Medicare Part A benefits when they care for patients who can’t easily leave their homes due to health issues.
  • To qualify, patients need visits from medical pros, a care plan from a certified doctor, or intermittent therapy.
  • Covered services under Part A include things like skilled nursing, physical therapy, and home health aides.

Part B Services:

  • If patients don’t meet the Part A criteria, they can still get paid through Part B using the Medical Physician Fee Schedule.
  • Part B covers the cost of treatment services and supplies, as well as preventive services to catch illnesses early.

Final Words

In Last it is worth saying that Telehealth has emerged as a game-changer, bringing convenience and accessibility to home health services. While it has improved reimbursements for providers, navigating the complexities of billing and coding remains a challenge. Recent CMS updates, including the introduction of Medicare G codes, have added a new dimension to the telehealth landscape. It’s crucial to remember that these services should always be part of a patient’s care plan, prescribed by a physician, and executed with precision. As healthcare providers adapt to these changes, they must also explore alternative reimbursement models to ensure the financial stability of their telehealth and RPM services.

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