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Issue Number - Name
0115-Home Visits Physician Services Overlapping Inpatient Stay
Review Type
Automated
Claim Type
Physician
Region and State
RACs 1-4
All MACs
Date Approved
2018-10-09

Description

Home Visits for physician services should not overlap an active inpatient stay. Providers cannot billed for services that are rendered.

Affected Code(s)

HCPCS/ CPT 64550, 90901, 90911, 92506-92510, 92521-92526, 92601-92616, 95831-95834, 95851, 95852, 96000-96003, 96105, 96125, 97001-97004, 97012-97799, 99500-99512, 99600-99602, 20999, A6457, G0151-G0164, G0193-G0201, G0279-G0300, G0329, G0456-G0457, G0490-G0496, H1004, Q5001, Q5002-Q5009, S5108-S5131, S5180-S5181, S9061, S9097, S9098, S9122-S9131, S9211-S9213, S9335, S9339, S9340-S9341, S9470, S9474, S9537-S9562, T1001-T1031, T1502

Applicable Policy References

Social Security Act: Section 1833(e)

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, Section 120.2 (B)