CMS Clarifies Effective Date of New G Codes

Home Health & Hospice Providers Should Update Software Settings.

Last week we posted a blog Updated RN and LPN G codes for Home Health and Hospice. The Centers for Medicare & Medicaid Services (CMS) has now released clarification that the effective date for the G Codes implemented to distinguish between RNs and LPNs applies to dates of service on or after January 1, 2016.  Creation of the new G codes was initially spurred by the need to distinguish between RN and LPN visits to implement the hospice Service Intensity Add-On (SIA) that goes into effect in January, but the new codes also apply to home health.

When CMS first issued Change Request (CR) 9369 to implement the new G codes on both home health and hospice claims, it was listed as being effective for hospice dates of services on and after January 1, 2016, and for home health episodes of care ending on or after January 1, 2016. The National Association for Homecare and Hospice (NAHC) reached out to CMS with concerns that the effective date for home health episodes of care that ended on January 1 would cause confusion and conflicted with the effective date for the new codes in the manual instructions.

NAHC announced on Friday, October 23rd that CMS confirmed that the effective date for home health claims for the new G codes is for all skilled nursing services billed with dates of service January 1, 2016 and later regardless of the episode start or end date.

  • Impact to Providers: Hospice and home health providers should begin the process of updating their RN and LPN profiles/settings within their software in advance of the January 1st effective date. Software programs will most likely be programmed to look for the new G0299 code for use in calculating hospice Service Intensity Add-On (SIA) and the new G codes will flow to claims/bills for both hospice and home health.

HEALTHCAREfirst will send clients that utilize one of HEALTHCAREfirst’s software product lines a document outlining how to update RN and LPN profiles/settings in the near future.

The new G codes for dates of service on or after January 1, 2016 are as follows:

  • RN – G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting
  • LPN – G0300 Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting

The full CR is available here.

October 27, 2015

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