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September 2021
Learn more about submitting authorizations for our new Medicare Advantage home health care program
What you need to know
We’re clarifying several key points about submitting authorizations for our new Medicare Advantage home health care program.
CareCentrix® began managing authorizations for home health care services for Medicare Plus Blue℠ and BCN Advantage℠ members as of June 1, 2021.
We’d like to provide additional information and clarification on several key aspects of this new program:
- For Medicare Plus Blue members who receive services in Michigan, you don’t need to submit requests to add disciplines to existing 30-day episodic authorizations that have already been approved by CareCentrix.
- For Medicare Plus Blue members receiving services outside of Michigan, follow the reimbursement guidelines for your local Blue plan.
- For BCN Advantage members, home health care services use a fee-for-service payment methodology. So you need to submit authorization requests for additional disciplines that haven’t been authorized by CareCentrix. See information below for additional details.
- For BCN Advantage members, you don’t need to update approved authorizations when services are provided by a clinician with a lower-level credential than the clinician who was authorized by CareCentrix. This substitution is allowed as long as the clinician with the lower-level credential is within the same discipline that CareCentrix authorized. For example:
- A licensed practical nurse can provide services when CareCentrix authorized services to be provided by a registered nurse.
- A physical therapy assistant can provide services when CareCentrix authorized services to be provided by a physical therapist.
Note: You also don’t need to update authorizations for Medicare Plus Blue members when services are provided by clinicians with lower-level credentials.
See the following table to determine which HCPCS codes are associated with revenue codes by discipline:
| Service |
HCPCS code |
Associated revenue codes |
| Home health aide |
G0156: Home health aide |
0570, 0571, 0572, 0579 |
| Medical social services |
G0155: Medical social worker |
0560, 0561, 0562 |
| Occupational therapy |
- G0152: Occupational therapist
- G0158: Occupational therapist assistant
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G0160: Occupational therapist, establish or deliver occupational therapy maintenance program
|
0430, 0431, 0432, 0434 |
| Physical therapy |
- G0151: Physical therapist
- G0157: Physical therapist assistant
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G0159: Physical therapist, establish or delivery physical therapy maintenance program
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0420, 0421, 0422, 0424, 0429 |
| Skilled nursing |
- G0299: RN visit
- G0300: Licensed vocational nurse/LPN visit
- G0162: RN, for management and evaluation of the care plan
- G0493: RN clinical assessment, initial
- G0494: LPN, for the observation and assessment of patient condition
- G0495: RN, training / education of a patient or family member
-
G0496: Practice nurse, training / education of a patient or family member
|
0550, 0551, 0552 |
| Speech therapy |
- G0153: Speech therapist
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G0161: Speech language pathologist, establish or deliver speech language pathology maintenance program
|
0440, 0441, 0442, 0444 |
We’re updating the Home health care: Frequently asked questions for providers document to reflect these clarifications.
As a reminder, CareCentrix manages prior authorizations for home health care services for Medicare Plus Blue and BCN Advantage members as follows:
- For episodes of care that start on or after June 1, 2021
- For episodes of care that started before June 1, 2021, when one of the following occurs on or after June 1: Recertification is needed, resumption of care is needed or there’s a significant change in condition
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