The Centers for Medicare & Medicaid Services (CMS) have issued some clarifications regarding the new G-Codes for reporting telehealth encounters on your home health claims. We will discuss the three new G-Codes and their effective dates. We will also provide some essential tips for reporting these G-Codes to ensure that you are assisting in the eventual reimbursement you deserve for telehealth services.  The new G-Codes are for information gathering only, at this time.  

New G-Codes for Telehealth Services  

Effective January 1, 2023, three new G-Codes have been introduced for reporting telehealth encounters on home health claims. These codes are optional until July 1, 2023, after which they become mandatory. The G0320 code is used for telehealth services that involve both audio and video components. For phone calls or audio-only services, use code G0321, and for remote patient monitoring, use code G0322.  

Reporting Remote Patient Monitoring  

When reporting remote patient monitoring on the claim, use the first date of service that remote patient monitoring began, and the units should reflect the total number of days. For the other two codes, the date that the telehealth encounter occurred should be reported, and the unit should reflect 15-minute increments of time that transpired during those visits.  

As always, it is essential to keep in mind that these telehealth services should be a part of the patient’s care plan, ordered by a physician, and carried out as directed

30-Day Claim for G-Codes  

The most recent clarifications from CMS include the question of whether a home health agency should report a 30-day claim if the only service on the claim are these three G-Codes. CMS’ answer is no. If there are no other skilled services to be reported on the claim, it should not be filed.  

Rejected Claims for Telehealth Services  

Since January 1, there have been some claim rejections or Returned To Provider (RTP) claims where there might have been a telehealth service, but there was not an actual skilled in-person visit on the claim of that same discipline. The edit that caused these rejections has now been turned off. So, in other words, you can have a telehealth visit by a nurse and a physical therapy skilled visit inperson on the claim, the claim should process and pay accordingly.  

Investigate and Report  

It is crucial to investigate these new G-Codes and to report them accurately on claims. CMS has issued these codes to make it easier for patients to receive care at home, and it is our responsibility as healthcare providers to ensure that we report them correctly.  

We have received several questions from agencies via email regarding clarifications in addition to the ones provided by CMS. We are encouraged by the fact that these questions have been raised, as it indicates that agencies are aware of the existence of G-Codes and the need to report them on claims for telehealth services in home health. If we fail to report these G-Codes on our claims, we may not ever see additional reimbursement for these services.  

We encourage you to investigate further and to report these codes accurately to ensure CMS has the data needed to eventually provide agencies with the reimbursement they deserve for telehealth services.   

For the CMS Transmittal link, click here.

If you have any questions or concerns, please do not hesitate to reach out to us, and we will be happy to assist you.  

Subscribe now to have our weekly Monday Minute with Melinda sent directly to your inbox. Click here to subscribe!