New Codes for Therapist Assistants Providing Maintenance Programs in Home Health Settings

CMS released CR 11721, which details new changes to the Home Health billing and processing instructions, including new G-codes that describe therapy assistant services. It also makes a correction to the processing of Home Health claims that receive episode sequence edits. Make sure that your billing staff are aware of these changes.

CMS now permits therapist assistants (rather than only therapists) to perform maintenance therapy under the Medicare Home Health benefit. CMS established a G-code for the maintenance
services furnished by a physical therapist assistant and a G-code for the maintenance services furnished by an occupational therapist assistant. The payment per visit will remain the same regardless of whether a therapist assistant is furnishing maintenance or other therapy services.

The two new G-codes are:

  • G2168: Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes. Short Descriptor: Svs by pt in home health
  • G2169: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes. Short Descriptor: Svs by ot in home health

Medicare systems will accept these claims when submitted after the implementation date of CR 11721 for dates of service on or after January 1, 2020. Home Health Agencies should:

  • Report G2168 with revenue code 042x on HH claims (Type of Bill (TOB) 032x other than 0322)
  • Report G2169 with revenue code 043x on HH claims TOB 032x other than 0322

CR 11721 also makes various clarifying changes to the Medicare Claims Processing Manual, Chapter 10, in order to better reflect the policies of the Patient-Driven Groupings Model. The revised Chapter 10 is a part of CR11721.

Click here to read the MLN Matters Article about these new changes.

Click here to read CR11721 in its entirety.

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