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Manual Pages Released for Home Health Code Conversion

June 1, 2016

Effective for dates of service on or after June 1, 2016, the current HCPCS Local Level III codes for Home Health Agencies (HHA) will be discontinued. The codes will be replaced by 11 new Health Insurance Portability and Accountability Act (HIPAA) compliant national and revenue codes. The HCPCS national code and revenue code will be required on all home health claims.

Every new Treatment Authorization Request (TAR) and electronic TAR (eTAR) submitted with dates of service on or after June 1, 2016, must include the HCPCS codes described below; the revenue code is not required. The Department of Health Care Services (DHCS) will provide directions at regular intervals, reminding providers to exhaust existing TARs and Service Authorization Requests (SARs).

Providers should review their inventory for previously approved TARs with HHA services that have dates of service on or after June 1, 2016. For those TARs, providers must submit a new TAR or eTAR with the appropriate HCPCS code to cover any remaining service period on or after June 1, 2016.

If the submitted TAR is for the purpose of updating the codes for the same authorization period, it will not be reviewed for medical necessity.

The conversion is as follows:

Current Billing New Billing
HCPCS Local Level III Code/Description National Code/Description Revenue Code/Description Authorization/Frequency Limitation/Comments
Z6900/Skilled nursing services HCPCS code G0154
Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes
0551
Skilled nursing/visit
TAR required except when services are in conjunction with the initial or six-month case evaluation.

Includes supplies that are used as part of the treatment visit.

No limit on the number of daily visits.

Z6902/Home health aide services HCPCS code G0156
Services of home health/hospice aide in home health or hospice setting, each 15 minutes
0571
Aide/Home Health/visit
Frequency limitation: As authorized.

Limited to 40 15-minute increments per day

Z6904/Physical therapy services HCPCS code G0151
Services performed by a qualified physical therapist in the home or hospice setting each 15 minutes
0421
Physical therapy/visit
TAR required except when services are in conjunction with the initial or six-month case evaluation.

Limited to one visit per day or four 15-minute increments.

Z6906/ Occupational therapy services HCPCS code G0152
Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
0431
Occupational therapy/visit
TAR required except when services are in conjunction with the initial or six-month case evaluation.

Limited to one visit per day or four 15-minute increments.

Z6908/Speech therapy services HCPCS code G0153
Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
0441
Speech pathology/visit
TAR required except when services are in conjunction with the initial or six-month case evaluation.

Limited to one visit per day or four 15-minute increments.

Z6910/Medical social services HCPCS code G0155
Services of clinical social worker in home health or hospice settings, each 15 minutes
0561
Medical social services/visit
TAR required except when services are in conjunction with the initial or six-month case evaluation.

Limited to one visit per day or four 15-minute increments.

Z6914/Case evaluation and initial treatment plan HCPCS code G0162
Skilled services by a registered nurse (RN) in the delivery of management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)
0583
Visit/Home Health/ assessment
Limited to one visit per day or four 15-minute increments. Four visits per every six months.
Z6916/Monthly case evaluation-extension of treatment plan HCPCS code G0162
Skilled services by a registered nurse (RN) in the delivery of management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)
0589
Visit/Home Health/other
Limited to one visit per day or four 15-minute increments. Four visits per every six months.
Z6918/Unlisted services including administered drugs and supplies HCPCS code A9999
Miscellaneous DME supply or accessory, not otherwise specified
0270
Medical/surgical supplies
The code combination A9999/0270 is for billing supplies.
CPT-4 code 99600
Unlisted home visit service or procedure
0589
Visit/Home Health/other
The code combination 99600/0589 is for billing services.

Respiratory therapist services can be authorized and billed under 99600.

Z6920/Early discharge follow-up visit CPT-4 code 99501
Home visit for postnatal assessment and follow-up care

CPT-4 code 99502
Home visit for newborn care and assessment
0580
Visit/Home Health
For follow-up of early Obstetrics (OB) discharge. This is an OB service, not a typical Home Health service.

Does not require a TAR.