Hospice Pre - Election Evaluation and Counseling Services (Rev. 2258)

by  Find-A-Code
July 20th, 2015

 
Effective January 1, 2005, Medicare allows payment to a hospice for specified hospice pre-election evaluation and counseling services when furnished by a physician who is either the medical director of or employee of the hospice.
 
Medicare covers a one-time only payment on behalf of a beneficiary who is terminally ill, (defined as having a prognosis of 6 months or less if the disease follows its normal course), has no previous hospice elections, and has not previously received hospice pre-election evaluation and counseling services.
 
HCPCS code G0337 “Hospice Pre-Election Evaluation and Counseling Services” is used to designate that these services have been provided by the medical director or a physician employed by the hospice. Hospice agencies bill their Medicare contractor with home health and hospice jurisdiction directly using HCPCS G0337 with Revenue Code 0657. No other revenue codes may appear on the claim.
 
Claims for “Hospice Pre-Election and Counseling Services”, HCPCS code G0337, are not subject to the
editing usually required on hospice claims to match the claim to an established hospice period.Further, contractors do not apply payments for hospice pre- election evaluation and counseling consultation services to the overall hospice cap amount.
 
Medicare must ensure that this counseling service occurs only one time per beneficiary by imposing safeguards to detect and prevent duplicate billing for similar services. If “new patient” physician services (HCPCS codes 99201-99205) are submitted by a Medicare contractor to CWF for payment authorization but HCPCS code G0337 (Hospice Pre-Election Evaluation and Counseling Services) has already been approved for a hospice claim for the same beneficiary, for the same date of service, by the same physician, the physician service will be rejected by CWF and the service shall be denied as a duplicate. Medicare contractors use the following messages in this case:
 
MSN messages: 16.8: “Payment is included in another service received on the same day” and 
 
16.45: “You cannot be billed separately for this item or service. You do not have to pay this amount.”
 
Claim adjustment reason code (CARC) 97:“The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.”
 
Remittance advice remark code (RARC) M86:
 
Likewise, if a “new patient” claim for HCPCS codes 99201-99205 has been approved and subsequently, a hospice claim is submitted to CWF for payment authorization for HCPCS code G0337, (for same beneficiary, same date of service, same physician), CWF shall reject the claim and the contractor shall deny the bill and use the messages above.
 
HCPCS code G0337 is only payable when billed on a hospice claim. Contractors shall not make payment for HCPCS code G0337 on professional claims. Contractors shall deny line items on professional claims for HCPCS code G0337 and use the following messages: 
 
MSN message 17.9: “Medicare (Part A/Part B) pays for this service. The provider must bill the correct Medicare contractor."
 
CARC 109: “Claim not covered by this payer/contractor. You must send the claim to the
correct payer/contractor.”

References:

Hospice Pre - Election Evaluation and Counseling Services (Rev. 2258). (2015, July 20). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/hospice-pre-election-evaluation-and-counseling-services-rev-2258-26643.html

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