G0300 — Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Medical records must fully characterize each behavioral disturbance by documenting: the specific behavior, its frequency, triggers, timing, location, persons involved, alternate explanations (e.g., pain, infection, medication change), consequences, prior successful interventions, and other potential techniques.
- The care plan must document that teaching/training interventions were selected based on the behavior assessment, identified impairments and activity limitations, caregiver ability to learn and implement, and environmental factors (WHO ICF recommended).
- Documentation should record demonstration and return-demonstration of techniques (nurse demonstrates with patient; caregiver provides return-demonstration observed by clinician).
- A physician order for skilled nursing teaching/training is expected (policy scenarios reference physician-ordered skilled nursing); the presence and details of the order should be documented in the medical record.
Key Coverage Criteria
- Home health skilled nursing teaching and training activities are covered for Medicare beneficiaries with dementia and behavioral disturbances when provided as part of a beneficiary-centered care plan to teach family members or caregivers how to manage the behavioral disturbances.
- Teaching/training is covered when behavioral disturbances complicate medical management and addressing them is necessary to prevent further deterioration of baseline impairments or activity limitations and to achieve clinically appropriate outcomes.
- Teaching/training is covered when interventions are based on a documented, specific characterization of the behavior (what it is, frequency, triggers, timing, location, participants, alternative explanations, consequences, prior successful interventions, and potential techniques).
- Teaching/training is covered when interventions are tailored to the beneficiary's specific impairments and activity limitations, the caregiver's ability to learn and implement interventions, and environmental factors (use of WHO ICF is recommended to facilitate documentation).
- Coverage for hospice renal care is determined by the Local Coverage Determination (LCD) L34559; refer to LCD L34559 for specific covered diagnoses and clinical criteria for hospice renal services.
- Coverage and clinical indications for hospice services for Alzheimer disease and related disorders follow the Local Coverage Determination LCD L34567 and associated clinical criteria therein.
20 Active Policies
AETNA-CPB-0201 — Skilled Home Health Care Nursing Services
AETNA-CPB-0329 — Home Births
AETNA-CPB-0541 — Dialysis
ANTHEM-CG-MED-71 — CG-MED-71 Chronic Wound Care in the Home or Outpatient Setting
ANTHEM-CG-MED-23 — CG-MED-23 Home Health
Related Codes
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