Question

If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form?  A modifier, or something else?

Answer

Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP on physical therapy services).

In most cases, you will simply use Place of Service (POS) code 12 on Item Number 24b of the 1500 Claim Form with the applicable procedure code to identify that the service took place in the home. However, if E/M services are provided, then you need to use the appropriate E/M Home Services CPT code 99341-99350 instead of the Office/Other Outpatient codes (99201-99215). Be sure to follow all key component rules and properly document the visit just as you would if the patient was in the office.

One important thing to remember is that payer requirements must be met. Prior to 2019, Medicare required that you document why it was medically necessary to provide these services in the home. Even though Medicare removed that rule, there might be other payers who still have a similar rule in place.