CMS is retiring the use of G0163 and G0164 HCPCS codes effective 1/1/2017.  Instead, the two G codes will expand out into four new G codes to separate the RN visits from the LPN visits.  Barnestorm has been setup to use the correct G codes on claims, as needed.  There are instructions below on how to know if the payer is setup to use the new codes automatically.  This change will affect Home Health Episodes only.

Excerpt from CMS Transmittal 9736

Creation of New G Codes for RN and LPN in Home Health Episodes

Given the reporting needs articulated above, CMS is requesting that G0163 and G0164 be retired, effective January 1, 2017, and instead replaced with four new G-codes:

1. G0493 - Skilled services of a registered nurse (RN) for the observation and assessment of the patient’s condition, each 15 minutes (the change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health or hospice setting).

2. G0494 - Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patient’s condition, each 15 minutes (the change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health or hospice setting).

3. G0495 - Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

4. G0496 - Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9736.pdf 

Below are the rules Barnestorm will follow when adjusting to the new G codes:

• When an RN uses G0163 HCPCS then the claim will show G0493; dates of service 1/1/17 and after.
• When an LPN uses G0163 HCPCS then the claim will show G0494; dates of service 1/1/17 and after.
• When an RN uses G0164 HCPCS then the claim will show G0495; dates of service 1/1/17 and after.
• When an LPN uses G0164 HCPCS then the claim will show G0496; dates of service 1/1/17 and after.

Special Note:

If a payer needs to be setup to use the new G codes, review the following process.

1. Go to Codes > Program Related Codes > Payer Codes and pull up the payer
2. Mark the option to Translate G0163/G0164 to G049X as Yes
3. Click on Save