Care Plan Oversight (CPO) Reimbursement

Medicare reimbursement for care plan oversight (CPO)services of home health and hospice patients has improved significantly.

Codes for care plan oversight are: GO181 for home health, and GO82 for hospice.

You may bill for 30 minutes of care plan oversight a month, including medical decision making; review of charts, reports, or treatment plans; review of lab or study results that weren't ordered during or associated with a face-to-face encounter; phone calls to other health professionals involved in the care of the patient; phoning in prescriptions; and other items on the home care or hospice patient's behalf.

Physicians are now also able to bill for services involved in certifying and recertifying home health plans of care.

The code for certification of plans of care is GO180. The code for recertification is GO179.

Physician Care Plan Oversight is defined as physician supervision of a patient (patient not present) under the care of a Medicare Certified Home Health Agency (HCPCS CODE G0181) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more.

To receive payment the physician:

• Must provide service to Medicare beneficiaries receiving covered home health/hospice services;
• Must have had a face to face encounter with the patient in the six months prior to the first billing for care plan oversight services; and
• May not have a relationship with the home health agency that is prohibited by the Stark II (Physician Self-Referral) regulation.

Please be aware that surgeons may bill for post-surgical care plan oversight if documentation shows the care is unrelated to the surgery.

Medicare requires the physician to document the services that were furnished, the date, and the length of time associated with those services. Tender Touch Health Care has created an editable and printable Physician Oversight Billing form to assist you in keeping track of this information. This form is for your personal billing use and does not need to be returned to Tender Touch Health Care. We send this form to the primary physician for each of our Medicare patients along with the Home Health Plans of Care for review and signature.

Certification And Re-Certification Services:

Physician Certification of Home Health Plan of Care (HCPCS Code G0180) is defined as physician services for initial certification of Medicare-covered home health services, billable once for a patient’s home health certification period. This code will be used when the patient has not received Medicare-covered home health services for at least 60 days.

Physician Re-certification of Home Health Plan of Care (HCPCS Code G0179) is defined as physician services for recertification of Medicare covered home health services, billable once for a patient’s home health certification period. This code would be used after a patient has received services for at least 60 days (or one certification period) when the physician signs the certification after the initial certification period.

We recommend that physicians retain a copy of the signed HCFA-485 (home health plan of care), signed interim or telephone orders, or any other documentation that would support provision of these services.

Billing Notes: Physicians bill for Care Plan Oversight or certification/recertification using Form HCFA 1500. The claim for these services must contain the home health agency’s 6-digit Medicare provider number. The dates of service should be the date the physician provided the service, not the Medicare beneficiary’s dates of services. Specifically, the dates of service on the HCFA 1500 should be:

• Care Plan Oversight: FROM the date of the first CPO service provided in the calendar month TO the date of the last CPO service provided in the calendar month.
• Certification/Recertification: The date the physician signs the plan of care.

Medicare requires the physician to document the services that were furnished, the date, and the length of time associated with those services. Tender Touch Health Care has created an editable and printable Physician Oversight Billing form to assist you in keeping track of this information. This form is for your personal billing use and does not need to be returned to Tender Touch Health Care. We send this form to the primary physician for each of our Medicare patients along with the Home Health Plans of Care for review and signature.

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