CMS Clarifies Effective Date for New G-Codes
October 23, 2015 03:46 PM
The Centers for Medicare & Medicaid Services (CMS) has clarified that the effective date for the G-Codes to differentiate Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) on home health and hospice claims will be for dates of service on or after January 1, 2016.
On October 16, 2015, CMS issued Change Request (CR) 9369, which implements two new G-Codes on both home health and hospice claims. In the CR, CMS states that these two G-Codes will be applicable 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. With the institution of the new codes, the existing “G0154 -- Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting” will be retired. CMS’ instructions that the change applies to home health episodes of care that end on 1/1/2016 has caused confusion and conflicts with the effective date for the new codes in the manual instructions.
The National Association for Home Care & Hospice received the following clarification from CMS. According to CMS, the policy statement ‘episodes ending’ is a bit unclear. The Health Insurance Portability and Accountability Act transactions and code sets rule requires that changes to medical code sets be effective according to the date of service. Therefore, only episodes that end on or after January 1, 2016 can be affected by this change. To further clarify, 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.