G0321 — Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
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
- A written order and direction from a treating practitioner or specialist (M.D., D.O., P.A., or N.P.).
- A plan of care demonstrating that the care is skilled in nature and requires clinical training to be delivered safely and effectively (i.e., documentation that the care cannot be safely provided by a non‑licensed caregiver).
- Documentation that services are delivered or supervised by a licensed professional and that delivery/supervision is necessary to obtain a specified medical outcome.
- Clinical records/notes showing the medical necessity for home-based skilled services (e.g., progress notes, assessment, evaluation, wound care documentation, therapy evaluations and treatment notes).
Key Coverage Criteria
- Home health and skilled care services are considered medically necessary in certain circumstances (refer to InterQual® LOC: Home Care Q&A: Home Care Services, Adult and Home Care Services, Pediatric for clinical coverage criteria).
- Short-term home health care services prescribed by a treating practitioner (M.D., D.O., P.A., or N.P.) delivered within the member's residence to help a member recover after an illness, injury, hospital stay, or surgery.
- Home health care services to help manage a chronic condition with the goal of preventing an unplanned hospitalization or prolonging a current hospitalization.
- Intermittent home health care services provided to restore or maintain a member's maximal level of function and health in lieu of receiving the services in an outpatient setting or in an acute or sub-acute health care setting.
- Skilled care services provided in the member's Place of Residence by licensed health care professionals when the care requires clinical training to be delivered safely and effectively.
- Skilled nursing and skilled rehabilitation (physical therapy, occupational therapy, and speech therapy) delivered in the home when such services require skilled/trained personnel.
2 Active Policies
UHC-POL-home-health-care — Home Health, Skilled, and Custodial Care Services
ANTHEM-CG-MED-23 — CG-MED-23 Home Health
Related Codes
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