Page 16 - Medicare Benefit Policy Manual

E. Completion of Claims Forms

Separate charges for the services of a physician in completing a Form CMS-1500, a
statement in lieu of a Form CMS-1500, or an itemized bill are not covered. Payment for
completion of the Form CMS-1500 claim form is considered included in the fee schedule
amount.

F. Care Plan Oversight Services

Care plan oversight is supervision of patients under care of home health agencies or
hospices that require complex and multidisciplinary care modalities involving regular
physician development and/or revision of care plans, review of subsequent reports of
patient status, review of laboratory and other studies, communication with other health
professionals not employed in the same practice who are involved in the patient’s care,
integration of new information into the care plan, and/or adjustment of medical therapy.

Such services are covered for home health and hospice patients, but are not covered for
patients of skilled nursing facilities (SNFs), nursing home facilities, or hospitals.

These services are covered only if all the following requirements are met:

1. The beneficiary must require complex or multi-disciplinary care modalities
requiring ongoing physician involvement in the patient’s plan of care;

2. The care plan oversight (CPO) services should be furnished during the period in
which the beneficiary was receiving Medicare covered HHA or hospice services;

3. The physician who bills CPO must be the same physician who signed the home
health or hospice plan of care;

4. The physician furnished at least 30 minutes of care plan oversight within the
calendar month for which payment is claimed. Time spent by a physician’s nurse
or the time spent consulting with one’s nurse is not countable toward the 30-
minute threshold. Low-intensity services included as part of other evaluation and
management services are not included as part of the 30 minutes required for
coverage;

5. The work included in hospital discharge day management (codes 99238-99239)
and discharge from observation (code 99217) is not countable toward the 30
minutes per month required for work on the same day as discharge but only for
those services separately documented as occurring after the patient is actually
physically discharged from the hospital;

6. The physician provided a covered physician service that required a face-to-face
encounter with the beneficiary within the 6 months immediately preceding the
first care plan oversight service. Only evaluation and management services are