Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2020 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Care Plan Oversight (CPO) refers to a physician's supervision of patients under care of home health agencies or hospices who require complex or multidisciplinary care modalities.
Note: Such services are not covered for patients of skilled nursing facilities (SNFs), nursing home facilities or hospitals.
CPO services require complex or multidisciplinary care modalities involving:
The CPO services require recurrent physician supervision of a patient involving 30 or more minutes of the physician’s time per month. Services not countable toward the 30 minute threshold that must be provided in order to bill for CPO include, but are not limited to:
Implicit in the concept of CPO is the expectation that the physician has coordinated an aspect of the patient’s care with the home health agency or hospice during the month for which CPO services were billed. The physician who bills for CPO must be the same physician who signs the plan of care.
Nurse practitioners, physician assistants, and clinical nurse specialists practicing within the scope of state law may bill for care plan oversight. These nonphysician practitioners must have been providing ongoing care for the beneficiary through evaluation and management services.
Note: These nonphysician practitioners may not bill for CPO if they have been involved only with the delivery of the Medicare-covered home health or hospice service.
Home Health CPO
Nonphysician practitioners can perform CPO only if the physician signing the plan of care provides regular ongoing care under the same plan of care as does the NPP billing for CPO and either:
Billing may be made for care plan oversight services furnished by an NPP when:
NPPs may not certify the beneficiary for home health care.
The attending physician or nurse practitioner (who has been designated as the attending physician) may bill for hospice CPO when they are acting as an “attending physician.” An attending physician is one who has been identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care. They are not employed nor paid by the hospice. The care plan oversight services are billed using Form CMS-1500 or electronic equivalent.
HCPCS Codes and Billing
G0179: MD recertification Home Health Agency (HHA) PT
G0180: MD certification HHA patient
G0181: Home health care supervision
G0182: Hospice care supervision
How to Submit a Claim
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 11/11/2019