# In home visits



## Kisselml (Apr 22, 2020)

Feeling a bit dumb here.  Home visits 99341 - 99350. When are these applicable, what circumstances? thx


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## SharonCollachi (Apr 22, 2020)

Medicare:  Home and domiciliary visits are when a physician or qualified non-physician practitioner (NPPs) oversee or directly provide progressively more sophisticated evaluation and management (E/M) visits in a beneficiary's home. This is to improve medical care in a home environment. A provider must be present and provide face to face services.  This is not to be confused with home healthcare incident to services. 

* Modalities*

Home and domiciliary visits require complex or multidisciplinary care modalities involving:

Services are covered only when the three key E/M components are met and documented in medical record and based on face-to-face time with patient 
History, exam and medical decision making
Time spent counseling and coordinating
Medical management

Services must meet need of medical necessity
These visits are an extension of normal care
There is* no *requirement that patient must be homebound
Beneficiaries seen may be disabled either physically or mentally making access to a traditional office visit very difficult, or may have limited support systems
 * Provider Eligibility*

Under provisions of the Balanced Budget Act of 1997, Physicians (MDs) and Qualified non-physicians Practitioners (NPPs) must be practicing within the scope of State law and may also bill for home and domiciliary visits.

* Medical Necessity*

The mere presence of inactive or chronic conditions does not constitute medical necessity for any setting (home, rest home, office etc.).



Chief complaint or a specific, reasonable, and medical necessity is required for each visit
A payable diagnosis alone does not support medical necessity of ANY service
Medical necessity must exist for each individual visit
Visit will be regarded as a social visit unless medical record clearly documents medical necessity for every visit
Service/visit must be medically reasonable and necessary and not for physician or qualified NPP convenience
Service must be of equal quality to a similar service provided in an office
Frequency of visits required to address any given clinical problem should be dictated by medical necessity rather than site of service
It is expected that frequency of visits for any given medical problem addressed in home setting will not exceed that of an office setting, except on rare occasion
Training of domiciliary staff is not considered medically necessary
 * Requirements*


Home visits services (CPT codes 99341-99350) may only be billed when services are provided in beneficiary's private residence (POS 12). To bill these codes, physician must be physically present in beneficiary's home.
The service must be of such nature that it could not be provided by a Visiting Nurse/Home Health Services Agency under Home Health Benefit
There may be circumstances where home health services and services of physician/qualified non-physician practitioners (NPPs) are performed on same day
These services cannot be duplicative or overlapping
Based on Consolidative Billing Regulations, no service will be covered under Medicare Part B when performed only to provide supervision for a visiting nurse/home health agency visit(s)
If a beneficiary is receiving care under home health benefit, primary treating physician will be working in concert with home health agency
 [See link in first paragraph for the rest of the article]


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## daedolos (May 11, 2020)

What is the modifier and POS for when this is telehealth?

Peace
?_?
Anxiously awaiting your reply.


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## SharonCollachi (May 11, 2020)

I would check the many, many other threads for telehealth, POS and modifiers.


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## dacia.carroll@antonellicollege.edu (Jun 11, 2020)

Good Morning, 

Is this information significant enough to bill Home Services? If so, would this be 99341?

CC: Exposure to COVID-19
HPI: COVID Test done today. 
ROS: Const, Eyes, ENT, Cardio, Respiratory, GI, GU, Musculo, Derm, and Neuro
PFSH: Medical Hx: Diabetes and Hypertension
Exam: Comprehensive 
Assessment: DX: Z20.828- Due to possible exposure, test done today. Self quarantine strongly recommended and red flags and renal complications. Follow up in 72 hours as a virtual/phone visit.


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