CMS Pub. 100-02, ch. 7, § 30.5.4

Recertification

(Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)

Certification and recertification claims are Part B claims paid for under the Physician Fee

Schedule. These claims are billed using HCPCS codes G0180 (certification) or G0179

(re-certification). The descriptions of these two codes indicate that they are used to bill

for certification or recertification of patient eligibility “for Medicare-covered home health

services under a home health plan of care (patient not present), including contacts with

the HHA and review of reports of patient status required by physicians or allowed

practitioners to affirm the initial implementation of the plan of care that meets patient's

needs, per certification period”. As noted above, these codes are for certification or

recertification for Medicare-covered home health services. If there are no Medicare-covered home health services, these codes should not be billed or paid. As such, claims

for certification/recertification of eligibility for home health services (G0180 and G0179,

respectively) will not be covered if the HHA claim itself was non-covered because the

certification/recertification of eligibility was not complete or because there was

insufficient documentation to support that the patient was eligible for the Medicare home

health benefit.