Description
Home Visits for physician services should not overlap an active Inpatient Stay. Physician claims billed with a home-related place of service that overlaps an inpatient hospital stay will be denied.
Affected Code(s)
90901, 90912, 90913, 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92601, 92602, 92603, 92604, 92605, 92606, 92607, 92608, 92609, 92610, 92611, 92612, 92614, 92616, 95851, 95852, 96000, 96001, 96002, 96003, 96005, 96125, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97537, 97542, 97545, 97546, 97597, 97598, 97602, 97605, 97606, 97750, 97755, 97760, 97761, 97763, 97799, 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99511, 99512, 99600, 99601, 99602, 20999, G0151, G0152, G0153, G0155, G0156, G0157, G0158, G0159, G0160, G0161, G0162, , G0279, G0281, G0282, G0283, G0299, G0300, G0329, G0490, G0493, G0494, G0495, G0496, H1004, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5009, S5108, S5109, S5110, S5111, S5115, S5116, S5130, S5131, S5180, S5181, S9097, S9098, S9122, S9123, S9124, S9127, S9128, S9129, S9131, S9211, S9212, S9213, S9335, S9339, S9340, S9341, S9342, S9343, S9470, S9474, S9537, S9538, S9542, S9559, S9560, S9562
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986- Good Cause for Reopening
7. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
8. Medicare Claims Processing Manual, Chapter 1- General Billing Requirements, §120.2(B)- Exact Duplicate Claims, Claims Submitted by Physicians, Practitioners, and other Suppliers (except DMEPOS Suppliers)
9. Medicare Claims Processing Manual, Chapter 26- Completing and Processing Form CMS-1500 Data Set, §10.5- Place of Service Codes and Definitions
10. Medicare Benefit Policy Manual, Chapter 15- Covered Medical and Other Health Services, §30- Physician Services
11. AMA CPT Codebook
12. HCPCS Level II Codebook