Physician house calls are making a comeback as they offer clear benefits for many patients and providers. But physicians making house calls also need to know about certain reimbursement and practical considerations. Refer to these tips and CPT codes next time you need to bill for a house call visit.

Considerations when billing for a house call

Medicare reimburses providers for home visits only if they are medically necessary. Healthcare.gov defines medically necessary services as “services or supplies that are needed to diagnose or treat a medical condition and that meet accepted standards of medical practice.”

In the case of house calls, physicians need to document that the home visit was medically necessary. In other words, you must present a medical – rather than practical – reason for visiting a patient outside the office. Here are a few other considerations to keep in mind when you bill for a house call:

  • Providers need to document if the home visit is based upon a one-time, ongoing or permanent need.
  • Documentation should prove that the patient is not physically capable of traveling to the office. You may base this assessment on physical or mental issues but not on financial or personal issues.
  • Home services can’t be provided for the physician’s convenience.
  • Patients receiving care under Medicare’s home health benefit must be confined to the home. However patients don’t need to be home bound for physicians to provide services billed under CPT codes 99341 through 99350.

The Office of Inspector General (OIG) and many CMS contractors regularly audit home services billed to Medicare. Make sure to provide appropriate documentation showing that the house call was medically necessary.

CPT Home Services Codes

Physicians use a limited set of CPT codes to bill for house calls. These codes apply to evaluation and management (E/M) services provided in a patient’s home. “Home” can include a private residence, temporary lodging or short term accommodation.

New patient CPT codes

99341 – Home visit for the evaluation and management of a new patient. This visit requires the following three components:

  1. A problem focused history
  2. A problem focused exam
  3. Straightforward medical decision making

Here’s a typical description for this code:

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or other agencies are provided consistent with he nature of the problem(s) and he patients’ and/or family’s needs.

Usually the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.

99342 – Same as above, but this is a moderate severity problem requiring 30 minutes.

99343 – Moderate to high severity problem requiring 30 minutes.

99344 – High severity problem requiring 60 minutes.

99345 – Patient unstable or significant new problem requiring immediate attention (75 minutes).

Established patient CTP codes

99347 – Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components.

  1. A problem focused interval history
  2. A problem focused examination
  3. Straightforward medical decision making

Here’s the typical description for this code:

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or other agencies are provided consistent with he nature of the problem(s) and he patients’ and/or family’s needs.

Usually the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.

99348 – Same as above, but this is problem is low to moderate severity requiring 25 minutes face-to-face.

99349 – Moderate to high problem requiring 40 minutes.

99350 – Patient unstable or significant new problem requiring immediate physician attention (60 minutes).

When making a house call, you may offer additional services such as advanced care planning, diagnosis services or other minor procedures. These can be documented and billed in addition to the visit code.

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