7 Services PCPs Forget to Bill For

Betsy Nicoletti, MS


June 12, 2018

In This Article

Pay Attention to Requirements for Getting Paid

2. Certification for Home Health Services

There are Healthcare Common Procedure Coding System (HCPCS) codes for certification and recertification of a patient for Medicare-covered home health services. These codes pay for the development and revision of the plan, reviewing information that is sent by the home health agency, updating orders, and the responsibility for oversight.

Why is it overlooked? Payment is not for simply signing the form, it is for the development and supervision of the home health services. Medical practices can set up a process for billing these at the time the form is signed by the physician. Recertification may be billed 60 days after the certification.

Because these are HCPCS codes, many practices aren't aware of them. When practices know about them, it can be difficult for the physician to charge for the service if there isn't an encounter to attach it to.

Code Description wRVUs National Non-facility Payment
G0180 Physician certification of Medicare-covered home health services 0.67 54.70
G0179 Physician recertification of Medicare-covered home health services 0.45 42.47

3. Smoking Cessation Counseling

There are two CPT codes to report one-to-one smoking cessation counseling with patients. For counseling lasting 3-10 minutes, use 99406. For counseling that lasts longer than 10 minutes, use 99407.

Why are they overlooked? Some practices don't bother with these codes because the reimbursement is low. And some practitioners do the work but don't document the time. Time must be documented in the note for time-based codes.

These codes may be reported on the same day as another E/M service, such as an office visit. If reporting them with an office visit, bill the level of E/M service based on the key components of history, exam, and MDM, and then add a statement about the amount of time spent in counseling for smoking cessation. The reimbursement isn't high for these services, but when multiplied by the number of conversations in a year, it can add up.

Code Description wRVUs National Non-facility Payment
99406 Behavioral change, smoking 3-10 minutes 0.24 14.76
99407 Behavioral change, smoking >10 minutes 0.5 28.43

4. Administration of Vaccine or Other Injections

When a staff member gives a patient a therapeutic injection or a vaccination in the office, there are CPT codes that describe that service. These should be billed whether the office provided the medication or the serum or if the patient or state supplied the medication or vaccine. The same is true for allergy injections.

Why are these overlooked? This may seem obvious, but these injection codes are frequently forgotten in medical practices. And if the practice purchased the medication or vaccine, be sure to bill for it as well. If the patient or state supplied the drug, bill only for the administration.

Code Description wRVUs National Non-Facility Payment
96372 Therapeutic injection 0.17 20.87
90471 Immunization administration 0.17 20.87
90472 Immunization administration, each additional component 0.15 12.96
95115 Immunotherapy (one injection) 0 9.00
95117 Immunotherapy injections (two or more) 0 10.44


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