"Homebound" for Housecalls?

Does a patient have to be “Homebound” in order to provide foot care services in the patient’s home?

Services Provided in the Home

Effective January 1, 2019, for services provided in the patient’s home, Medicare does not require that the patient be “Homebound”, nor do there need to be extenuating circumstances to necessitate the home visit. Medicare will pay for home services based on Medical Necessity. Based on the Medicare Carriers Manual, Section 15515, Medicare will pay for home service codes when they are billed to report an E/M service provided in the home. The physician must actually be present in the home of the beneficiary. It is not necessary that the patient be confined to the home. A patient’s home may be his/her own dwelling, an apartment, a relative’s home, a home for the aged, a retirement community, a senior citizen facility, or another type of senior living accommodation.

(MCM Section 2051.1 ) Homebound Criteria is no longer a requirement for a house call to be performed.

Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350

Coding Updates:

• •      Deletion of Home or Residence Services E/M code 99343
• •      Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines

Home or Residence Services New Patient:

• •      99341 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straight forward medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
• •      99342 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• •      (99343 has been deleted. To report, see 99341, 99342, 99344, 99345)
• • ​​​​​​​     99344 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• • ​​​​​​​     99345 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Home or Residence Services Established Patient:

• • ​​​​​​​     99347 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
• • ​​​​​​​     99348 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• • ​​​​​​​     99349 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  •      ○     When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
• • ​​​​​​​     99350 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  •      ​​​​​​​○     When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

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This is my opinion.

Michael G. Warshaw

DPM, CPC

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