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Looser home-visit policy: Now even more official

A policy change that gives greater freedom to providers who report home-visit services (99341-99350) became more fully entrenched after a May 24 update to the Medicare Claims Processing Manual.
Whereas providers previously had to prove the medical necessity behind a visit that took place in the home instead of the office,, the revised policy removes the strict medical-necessity requirement. CMS first announced the change within the 2019 Medicare physician fee schedule, and it took effect Jan. 1.
Until the end of May, however, standing guidance may have sown confusion. Chapter 12 of the Claims Processing Manual continued to state that "the medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit."
But look to the Manual now and you'll find no such language. CMS removed the "in lieu of" policy in the May 24 update, and the guidance within the Manual now states simply: "Home services codes 99341-99350 are paid when they are billed to report evaluation and management services provided in a private residence."
The only reporting stipulation is that "a home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home," the Manual states.
But beware: Even as the edit gets baked into Medicare guidance, practices that report home-visit codes should watch their claims. The updated policy spelled out in the Claims Processing Manual is effective Jan. 1, 2019, but the implementation date for Medicare administrative contractors (MACs) doesn't occur until Aug. 27. That means your payers may be slow to come around to the documentation change.
If that's the case, point them to the fresh sections of the Claims Processing Manual to support your case. Here's a direct link to the revised guidance:
Blog Tags: CMS, E/M services
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