CMS Pub. 100-04, ch. 12, § 180.1

A. Codes for Which Separate Payment May Be Made

Effective January 1, 1995, separate payment may be made for CPO oversight services for

30 minutes or more if the requirements specified in the Medicare Benefits Policy Manual,

Chapter 15 are met.

Providers billing for CPO must submit the claim with no other services billed on that

claim and may bill only after the end of the month in which the CPO services were

rendered. CPO services may not be billed across calendar months and should be

submitted (and paid) only for one unit of service.

Physicians may bill and be paid separately for CPO services only if all the criteria in the

Medicare Benefit Policy Manual, Chapter 15 are met.

B. Physician Certification and Recertification of Home Health Plans of Care

Effective 2001, two new HCPCS codes for the certification and recertification and

development of plans of care for Medicare-covered home health services were created.

See the Medicare General Information, Eligibility, and Entitlement Manual, Pub. 100-01,

Chapter 4, “Physician Certification and Recertification of Services,” §10-60, and the

Medicare Benefit Policy Manual, Pub. 100-02, Chapter 7, “Home Health Services”, §30.

The home health agency certification code can be billed only when the patient has not

received Medicare-covered home health services for at least 60 days. The home health

agency recertification code is used after a patient has received services for at least 60

days (or one certification period) when the physician signs the certification after the

initial certification period. The home health agency recertification code will be reported

only once every 60 days, except in the rare situation when the patient starts a new episode

before 60 days elapses and requires a new plan of care to start a new episode.

C. Provider Number of Home Health Agency (HHA) or Hospice

For claims for CPO submitted on or after January 1, 1997, physicians must enter on the

Medicare claim form the 6-character Medicare provider number of the HHA or hospice

providing Medicare-covered services to the beneficiary for the period during which CPO

services was furnished and for which the physician signed the plan of care. Physicians

are responsible for obtaining the HHA or hospice Medicare provider numbers.

Additionally, physicians should provide their UPIN to the HHA or hospice furnishing

services to their patient.

NOTE: There is currently no place on the HIPAA standard ASC X12N 837 professional

format to specifically include the HHA or hospice provider number required for a care

plan oversight claim. For this reason, the requirement to include the HHA or hospice

provider number on a care plan oversight claim is temporarily waived until a new version

of this electronic standard format is adopted under HIPAA and includes a place to

provide the HHA and hospice provider numbers for care plan oversight claims.