CPT codes for House Calls

npbag197.jpgI’ve been getting lots of questions about coding for House Calls, and what codes to use.   Here are the current codes that are listed for house calls as well as codes used for assisted living. For the exact details of what is included with each code, please check your CPT manual.

Code Description
99324 – 99328 Domiciliary or rest home visit for the evaluation and management of a new patient
99334 – 99337 Domiciliary or rest home visit for the evaluation and management of an established patient
99341-99345 Home visit for the evaluation and management of a new patient
99347 -99350 Domiciliary or rest home visit for the evaluation and management of an established patient

You will need to visit your Medicare provider in order to get the current rates from Medicare. If you are unsure who is your intermediary, check your copy of the Nurse Practitioner Business Resource Directory. I have included a full list of providers from around the US. It was current as of the publication date.

Comments

  1. paula says

    Thanks for posting these codes. I do not have a cpt manual (as far as I know). I see there are ranges for the codes, how do you know which code to use?
    paula

  2. says

    Paula,

    The guidelines for use of the codes are listed in the CPT book. I cannot publish the entire thing as the AMA owns the rights to the codes and frowns on unlicensed duplicaiton of their codes.

    In general, the lower codes are less complicated visits and thus less documentation, while the higher codes are for more complicated visits. There is also a difference between new and established visits.

    Your employer should have a CPT book available for you to use. These books change every year, and it’s important that you have updated codes – both ICD9 and CPT.

    If you are self employeed, it is essential you have proper coding references available to you. I get my books along with my subscription of http://www.FlashCode.com. It’s well worth the price for me.

    There are several books you can purchase. I use this one, again, for me, the ICD9, HCPCS and CPT book is included with my subscription to FlashCode.

    Let us know if you can get your hands on a CPT manual.

    Barbara

  3. says

    Hi Mona,

    I don’t know if there are CPT codes for psychiatric house call visits. I did search google for “cpt psychiatric home visits” and came up with a document out of California MediCal that may answers some questions (couldn’t get the link to paste correctly). Otherwise I would try medicare.

    One thing to remember with Medicare, they reimburse about 50% lower for a psych ICD9 code than for a “medical” code. At least that has been my experience.

    Here is an article out of the most recent issue of JAMA:
    http://jama.ama-assn.org/cgi/content/full/294/19/2435-a

    This is from the American Academy of Home Care Physicians – their FAQ where a similar question is addressed:
    http://www.aahcp.org/faq.shtml

    You might also check with your medicare carrier and your professional organization. Hopefully someone will have another source for you.

    Let us know if this helps!

    Barbara/NPBO

  4. JERRY says

    WE HAVE A LARGE PRACTICE THAT SEE THE PATIENTS IN THEIR HOMES. DUE TO THE LARGE NEED, WE HAVE BEEN DOING SPIROMETRY TEST IN THE PATIENTS HOME AND BILLING MEDICARE 94010 OR 94060. WHEN WE DO THIS IN THE CLINIC, PAYMENT IS FINE. BUT MEDICARE IS NOT PAYING WHEN DONE IN THE HOME, DESPITE THE FACT THAT OUR PATIENTS ARE HOME BOUND PATIENTS. ANY SUGGESTIONS

  5. says

    Hi Jerry,

    I posed this questions to Sharmaine Lawson-Baker, DNP who has a house call practice in New Orleans. She tells me she uses 94620 and has not had any problems with reimbursement.

    Barbara/NPBO

  6. says

    Hi
    I have had my own private house call business over 7 years in Tacoma, Washington. I enjoy it very much but I have cancer and need to go to part time work. I am wondering if it is possible to sell practice? It has done very well and would be sad to see it end. Do you have any suggestions as to where to post this online?

    http://gigihardtke.blogspot.com/

    Joanne Gigi Hardtke

  7. Hotelling says

    Can a NP visit patients at patient’s homes? Can NP select any visit code such as 99341-99350 just like Physician. Do physician need to be present with NP at patient’s homes? Can NP order Therapy, Nurse services. Do the patient have to bed Homebound to visit a patient at home. Does M edicare pay less if NP selects 99350( for example) compared to physican?

    Please send your answers and also pl send me useful links in Medicare or other web sites.

  8. says

    Yes, NPs can do house calls and use the same codes. No the physician does not need to be present, but always clarify state practice requirements for rules about collaboration.

    In most states NPs can order therapy, but not home health or hospice.

    You can find more information regarding Medicare requirements at http://www.cms.gov or your local Medicare carrier.

  9. jessica says

    Hi for a doctors home visit we bill the codes listed above but does medicare pay for any costs such as transportation of equipment and such. I know for mobile x-rays they pay for traveling costs as well as costs for taking the equipment and setting up. Does this apply for doctors doing home visits? Although they wont be doing ultrasounds they will be doing EKG’s. Do you know about this? Thank you.

  10. says

    Jessica,

    It’s my understanding that your travel cost are not paid for when doing house calls. Of course, any billable procedures being done such as an EKG would be covered as well as the evaluation and management of the patient.

    Hope this helps.

    Barbara

  11. beth says

    HI Barbara,

    Can medical nutrition therapy bill these codes for house calls? Are there other codes for house calls, if any?

  12. says

    Hi Beth,

    I’ve not found any information on this. Your best bet is to contact your local medicare carrier and individual insurance payers, and see if they can point you in the correct direction. Each insurance company may have additional requirements (particular diagnosis; home-bound status, etc) Using the appropriate CPT codes for nutritional counseling (97802-04) may or may not require a particular “place of service” code.

    Best wishes.

    Barbara

  13. Hotelling Ck says

    I have received A letter from Trust solutions that PA and NP can not see patients at home without Physician is present. I am planning to write to him that he does not know Medicare rules, or else can you suggest the approach I should use.

  14. John Losan says

    I am not a certified Medical Biller. However, I tried to learn and started billing for my wife. The reason was, the billing company my wife had was not re-billing, nor telling if there are rejections. Originally Medisoft was set for single provider. However, we hired NPs and PAs as well as a Doctor for visiting patients at patients homes. I applied and got Medicare PINs for all providers. However, I did not realize that I did not make changes to Medisoft to set it as a Group Practice. So, even though I created all providers and billing under each provider, the billing was going on group NPI which defaulted to my wife’s NPI. I could not realize that error until recently. I was indicted for billing fraudulently. However, I have no intentions to defraud anyone, nor cheat the government. I did not bill anything extra. I billed for what providers ordered And seen only however, when the claims went to Medicare electronically the NPI No is shown in 1500 form is my wife’s. How to explain this to Trust Solution and Government? Did anyone made these kinds of mistakes that you know and can you tell me how they proved themselves innocent?

  15. says

    John,

    I know there is an appeal process to the RAC audits. In this case you may need to find an attorney or other qualified professional to assist.

    As I said above, the RAC contractors make money when they can show fraud – intentional or not.

  16. Raja says

    Hi Barbara,
    Can you please tell me whether Medicare Part B covers psychiatrist services in house call or not. I know you have already replied the similar type of question in 2008 but I am just ensuring as there are lots of changes.
    We have doctors who are doing house call services and they are referring patients to psychiatrist and we already have the psychiatrist specialist in our practice who can render the services.
    Thanks in advance.
    Raja

  17. says

    Hi Robin,

    Yes, in most cases. Oftentimes, when adding a separate procedure onto an E&M visit, you’ll need to add a modifier code – 25. It’s important to make sure your documentation supports both the visit and the procedure.

    Barbara

  18. chakra says

    I read in CMS that Trust Solution has total authority to decide which claims are Medically Unnecessary. I have 3 NPs in my practice. After we got paid for the visits, we I received a notice from Trust Solutions that most claims were medically unnecessary and requested me to payback. Patients are elderly, sick, obese, back pain etc. How can I prove it to them?

  19. says

    If you know that these visits meet criteria for Medicare, then attempt to appeal. You’ll need to provide documentation. If that fails, then you will likely need to contact an attorney is is familiar with these issues.

  20. says

    In most cases an RN or LPN is working for a home health agency, or another provider, and services are generally billed through these employers. As a stand alone independent provider…I don’t believe RNs and LPNs quality.

  21. Donna Gilam says

    Can you explain this RULE:
    1. Does “Physician” means in this context anyone NP, PA and /or MD?
    2. Or NPs can not bill 99341-99350 at all UNLESS PHYSICIAN ALSO AT PHYSICIAN’S HOME?
    3. Or NPs CAN NOT DO HOME VISITS ALONE?
    PLEASE EXPLAIN

    **************************************************************************
    30.6.14.1 – Home Services (Codes 99341 – 99350)
    (Rev. 1, 10-01-03)
    B3-15515, B3-15066
    A. Requirement for Physician Presence
    Home services codes 99341-99350 are paid when they are billed to report evaluation and management services provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home

  22. Delores says

    hello, I am an LPN working at a physicans office, if my Doc asks me to do a home visit on a patient to do an assessment for a specific disease process or give a flu shot 1) is that legal and allowed and 2) what billing code would be used as all orders are coming directly from my physician and lastly do I need a special locked case to to carry chart to stay in compliance with hippa regulations. Thank you PS. I was a visiting nurse for 15 years prior to taking a position at a physicians office so I am familiar with said duties, only difference is this is for a PCP not an agency. Thanks again also this is the state NJ

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