CMS Pub. 100-04, ch. 4, § 290.5.2

Furnished Beginning January 1, 2008

(Rev. 3425, Issued: 12-18-15, Effective: 01-01-16, Implementation: 01-04-16)

Direct referral for observation is reported using HCPCS code G0379 (Direct referral for

hospital observation care). Prior to January 1, 2010, the code descriptor for HCPCS code

G0379 was (Direct admission of patient for hospital observation care). Hospitals should

report G0379 when observation services are the result of a direct referral for observation

care without an associated emergency room visit, hospital outpatient clinic visit, or

critical care service on the day of initiation of observation services. Hospitals should only

report HCPCS code G0379 when a patient is referred directly to observation care after

being seen by a physician in the community.

Payment for direct referral for observation care will be made either separately as a

hospital visit under APC 5013 (Level 3 Examinations & Related Services) or packaged

into payment for comprehensive APC 8011 (Comprehensive Observation Services) or

packaged into the payment for other separately payable services provided in the same

encounter. For information about comprehensive APCs, see §10.2.3 (Comprehensive

APCs) of this chapter.

The criteria for payment of HCPCS code G0379 under either APC 5013 or APC 8011

include:

1. Both HCPCS codes G0378 (Hospital observation services, per hr.) and G0379

(Direct referral for hospital observation care) are reported with the same date of

service.

2. No service with a status indicator of T or V or Critical Care (APC 5041) is

provided on the same day of service as HCPCS code G0379.

If either of the above criteria is not met, HCPCS code G0379 will be assigned status

indicator N and will be packaged into payment for other separately payable services

provided in the same encounter.

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

for a comprehensive APC payment through the Comprehensive Observation Services

APC (APC 8011).