On November 4, 2022, CMS released the 2023 Home Health Final Rule (CMS-1766-F). This final rule includes instructions for reporting telecommunication services on home health claims with newly billed G-codes.
Previously, the collection of data on telecommunication services was limited to overall cost data within the administrative costs line on the Home Health Agency (HHA) Medicare cost report. These costs were, therefore, factored into the costs per visit calculated within the Medicare cost report. The 2023 Home Health Final Rule implements a provision to capture volume data related to telecommunication services, via home health claim submissions.
Collecting telecommunication services data on home health claims also will allow CMS to analyze the characteristics of patients using these remote services. In addition, it's expected to give a better understanding of the social determinants that affect who benefits most from these services and what barriers may potentially exist for patients.
Three New G-Codes
- G0320 – Home health services furnished via a real-time, two-way audio and video telecommunication system.
- G0321 – Home health services furnished via a telephone or other real-time interactive audio-only telecommunication system.
- G0322 – Collections of physiologic data digitally stored and/or transmitted by the patient to the HHA, i.e., remote patient monitoring.
Dates to Know
- January 1, 2023 – Agencies may voluntarily report telecommunication services on home health claims with payment periods that start on or after January 1, 2023.
- July 1, 2023 – Agencies are required to report telecommunication services on home health claims with payment periods that start on or after July 1, 2023.
Clinical Considerations for Telecommunication Services
- They must specifically be included in the patient plan of care.
- The medical record must be documented to show how the technology helps to achieve the goals outlined in the patient plan of care.
- They cannot be a substitute for in-person home health services ordered as part of the patient plan of care.
- They are not considered “visits” for purposes of eligibility or payment.
- They will not factor into case-mix weights, outlier calculations, or low utilization payment adjustment thresholds per payment period for payment purposes. See Home Health Payment Rates at forvismazars.us for additional payment rate information.
Billing/Claim Considerations for Telecommunication Services
- The G-codes should only be reported with revenue codes 042x, 043x, 044x, 055x, 056x, and 057x.
- G0320 and G0321 will be reported on claims as separate dated lines with the appropriate revenue code for each discipline.
- G0322 remote patient monitoring will be reported on claims as a single line item, with the number of days of monitoring in the units field.
Recent Billing/Claim Developments
- Initially, Change Request 12805 required Medicare Administrative Contractors to Return to Provider (RTP) with reason code 31869, claims containing telecommunication codes if there was not another line item on the claim for an in-person visit with the same revenue code.
- This RTP reason code 31869 edit resulted in claims being returned in error and was turned off as of February 4, 2023.
- Claims already submitted which RTP’d for this reason can be resubmitted for processing.
If you have questions or need assistance, please reach out to a professional at Forvis Mazars.