Reimbursement and Practical Considerations for House Call Practices
House Calls are Back!
Lately, we’ve heard from more and more nurses and physicians who are exploring innovative care delivery models focused on more intimate connections with patients, increasing access to care by breaking down transportation barriers, and breaking free from the four walls of the traditional clinical practice—house calls are back! Physician house calls, while by no means a new concept, are nonetheless having a resurgence in popularity as payors begin to adjust to alternative payment and care delivery models that put patients first.
Are you thinking about starting a new house call practice? If so, you should know that the healthcare reimbursement system is not built to accommodate this model. Those wishing to take advantage of this model should be prepared for the special challenges presented by traveling to patient homes, how to avoid clashing with home health businesses, and the specific reimbursement pathways available.
Nixon Law Group has compiled the below infographic and CPT code summary based on its work in this area. Read more below and feel free to contact us with questions!
Click here to discover how we help providers explore and implement new and innovative payment models
CPT Codes and Reimbursement for House Call Services
There are a limited set of CPT codes clinicians performing house calls can bill. These CPT 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 (includes hotels, campground, etc.). Below you can find a summary of the available codes and related requirements.
New Patient Codes
CPT Code 99341
Home visit for the evaluation and management of a new patient, which requires these 3 components:
A problem focused history;
A problem focused exam; and
Straightforward medical decision making.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually the presenting problem(s) are of low severity. Typically, 20 minutes spent face-to-face with the patient and/or family.
CPT Code 99342
Home visit for the evaluation and management of a new patient, which requires these 3 key components:
An expanded problem focused history;
An expanded problem focused examination; and
Medical decision making of low complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
CPT Code 99343
Home visit for the evaluation and management of a new patient, which requires these 3 key components:
A detailed history;
A detailed examination; and
Medical decision of moderate complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
CPT Code 99344
Home visit for the evaluation and management of a new patient, which requires these 3 key components:
A comprehensive history;
A comprehensive examination; and
Medical decision of moderate complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
CPT Code 99345
Home visit for the evaluation and management of a new patient, which requires these 3 key components:
o A comprehensive history;
o A comprehensive examination; and
o Medical decision of high complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
Established Patient Codes
CPT Code 99347
Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:
o A problem focused interval history;
o A problem focused examination; and
o Straightforward medical decision making.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s 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.
CPT Code 99348
Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:
An expanded problem focused interval history;
An expanded problem focused examination; and
Medical decision making of low complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
CPT Code 99349
Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:
o A detailed problem focused interval history;
o A detailed problem focused examination; and
o Medical decision making of moderate complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
CPT Code 99350
Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:
A comprehensive interval history;
A comprehensive examination; and
Medical decision making of moderate to high complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.
Do you have questions or are you looking for more information? Contact us today!