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Clarification: Unconverted HHA Codes Do Not Require Revenue Code

December 6, 2016

To ensure timely and accurate reimbursement, all Home Health Agencies (HHA) or any authorized provider types submitting claims using any HCPCS code not addressed by the June 2016 home health code conversion should continue billing the appropriate HCPCS code without including a revenue code.

Reminder
Effective for dates of service on or after June 1, 2016, local HCPCS Level III codes for HHA listed in the left column of the table below have been discontinued. The codes have been replaced by the 11-HIPAA compliant code combinations listed in the National and Revenue codes columns. The HCPCS national code and revenue code will be required on all home health claims in place of the discontinued local codes.

This information was originally published as Manual Pages Released for Home Health Code Conversion on the HIPAA on the HIPAA: Code Conversion page of the Medi-Cal website.

The conversion is as follows:

HCPCS Local Level IIICode/ 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 & evaluation of the plan of care; each 15 minutes
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
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.