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G0179 FREQUENCY CALCULATOR

Use this calculator to determine the date the next recertification code G0179 may be billed. Enter the date of the last recertification or certification service that met the billing requirements for code G0179 or G0180 in MM/DD/YY or MM/DD/YYYY format and select Calculate. Select the Reset button to clear all data and submit a new query.

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DATE OF LAST G0179 OR G0180 =


 

The home health agency (HHA) certification code can be billed only when the patient has not received Medicare-covered home health services for at least 60 days. The HHA recertification code is used after a patient has received services for at least 60 days (or one certification period) when the physician signs the certification after the initial certification period. The HHA recertification code will be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapse and requires a new plan of care to start a new episode.

G0179 - MD recertification HHA PT
G0180 - MD certification HHA PT

Counting Initial Episodes

The "from" date for the initial certification must match the Start of Care (SOC) date, which is the first billable visit date for the 60-day episode. The "to" date is up to and including the last day of the episode, which is not the first day of the subsequent episode. The "to" date can be up to but never exceed a total of 60 days, which includes the SOC date plus 59 days.

Counting Subsequent Episodes

If a patient continues to be eligible for the home health benefit, the home health Prospective Payment System (PPS) permits continuous episode recertifications. At the end of the 60-day episode, a decision must be made whether to recertify the patient for a subsequent 60-day episode. An eligible beneficiary who qualifies for a subsequent 60-day episode would start the subsequent 60-day episode on day 61. The "from" date for the first subsequent episode is day 61 up to and including day 120. The "to" date for the subsequent episode in this example can be up to but never exceed a total of 60 days, which includes day 61 plus 59 days.

Note that the certification or recertification visit can be done during a prior episode.

 

Example:

The first 60-day episode ended 06/01. A new episode will begin 06/02 (on the 61st day) and continue through 07/31. The next episode can start 08/01, which is the 61st day.

Reference: Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-02,Medicare Benefit Policy Manual, Chapter 7, Section 10.4 (595 KB)

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