Allegheny Messages

Medicare will be retiring G Code G0154 for Home Health and Hospice.  Beginning for Hospice date of service on or after January 1, 2016 and for Home Health episodes ending on or after January 1, 2016, agencies will need to report new G/HCPCS Code G0299 for “Direct skilled nursing services of a Registered Nurse- RN in the Home Health or Hospice Setting”.  Agencies will need to use new G/HCPCS Code G0300 to report “Direct skilled nursing services of a Liscensed Practical Nurse-LPN in the Home Healt or Hospice setting.

Agencies must have Main Office Software version 5854 dated 10/28/15 prior to initiating new G Code set up in the software.

Agencies currently using different service codes for RN and LPN visits can update the HCPCS field with the new G code.

Agencies that do not currently differentiate in services between RN and LPN visits will need to update their current Skilled Nursing Visit service to reflect the RN visit and enter the new RN G Code in the HCPCS field.  Agencies will then need to add a new service for the LPN Skilled Nursing Visit using the new G code for services by an LPN in the HCPCS field.  The Service or Revenue code remains the same for both visits and unchanged from previously required 0551.

When invoicing Medicare Home Health and Hospice, the software will look at the date of the visits being reported.  If the date of service is prior to January 1, 2016, the software will replace the new G Codes with Go154.  When invoicing for dates of service on or after January 1, 2016 the software will use the new G codes already attached to the visits by complying with the previously detailed set up instructions.

ADDITIONAL IMPORTANT SERVICE SET UP TO CONSIDER:

Agencies using the Service Billing Rate tab for both Medicare and other Commercial Insurance billing codes and rates will need to add medicare in the Insurance Company Rates tab grid with the new G code/HCPCS with the original revenue code and billing rate.  The new G code is required specifically for Medicare Home Health and Hospice.  Agencies should contact their commercial insurance or Medicare Advantage/ HMO plans to verify if any changes are required for those payers.

Agencies that have Medicare or Medicare Hospice already entered in the Insurance Company Rates tab will just need to update the existing record.  A new record line for Medicare or Medicare Hospice should NOT be added.