Hospice docs can furnish consultation under new HCPCS code.
Starting in January, hospices will have one more way to secure reimbursement for their services from the Medicare program.
The Centers for Medicare & Medicaid Services has established HCPCS code G0337, which will allow hospice medical directors or other hospice-employed physicians to furnish pre-election hospice evaluation and counseling services.
"Many hospices may be very happy to take advantage of the provision for a hospice consultation visit," predicts clinical consultant Judy Adams with LarsonAllen Health Care Group based in Charlotte, NC. Hospices will bill the service to their regional home health intermediary.
CMS will reimburse the G code at $54.57, according to the final physician fee schedule published in the Nov. 15 Federal Register. But parties who commented on the proposed schedule argued that payment "does not accurately reflect the complexity associated with the hospice consultation," CMS says in the final rule.
Commenters also wanted payment to depend on the length and intensity of the consultation.
CMS says its hands are tied on these issues by the specifics in the Medicare Modernization Act, which enacted the new service.
While the payment isn't enough to compensate physicians adequately, "many hospice medical directors who have a strong commitment to hospice will still welcome this change as a movement in the right direction," Adams expects.
The new service comes with restrictions and requirements, CMS noted in its Nov. 9 Open Door Forum for home care providers. Hospices should note these specifics:
More detailed billing and other instructions will be forthcoming in Medicare correspondence soon, a CMS official said in the forum.