CMS Pub. 100-04, ch. 4, § 290.4.2

Observation Services Furnished Between January 1, 2006 and

December 31, 2007

(Rev. 1760, Issued: 06-23-09; Effective Date: 07-01-09; Implementation Date: 07- 06-09)

In order to receive separate payment for a direct referral for observation care (APC

0604), the claim must show:

1. Both HCPCS codes G0378 (Hourly Observation) and G0379 (Direct Admit to

Observation) with the same date of service;

2. That no services with a status indicator T or V or

Critical care (APC 0617) were provided on the same day of service as HCPCS

code G0379; and

3. The observation care does not qualify for separate payment under APC 0339.

Only a direct referral for observation services billed on a 13X bill type may be considered

for a separate APC payment.

Separate payment is not allowed for HCPCS code G0379, direct admission to observation

care, when billed with the same date of service as a hospital clinic visit, emergency room

visit, critical care service, or “T” status procedure.

If a bill for the direct referral for observation services does not meet the three

requirements listed above, then payment for the direct referral service will be packaged

into payments for other separately payable services provided to the beneficiary in the

same encounter.