2025 CPT code 99600
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Home Health - Unlisted Procedures Medicine Services and Procedures > Home Health Procedures and Services Feed
Unlisted home visit service or procedure.
Modifiers may be applicable depending on the specific circumstances.Consult the CPT manual and payer guidelines for appropriate modifier usage.
The medical necessity for the unlisted service must be clearly documented. This involves demonstrating that the service is reasonable and necessary for the patient's medical condition and that it is not duplicative of other services.
The provider performs a home visit service or procedure not covered by a specific CPT code.Detailed documentation is essential to justify the service and support the claim.
- Medicine Services and Procedures > Home Health Procedures and Services
- Medicine Services and Procedures > Home Health Procedures and Services
In simple words: This code is for a home healthcare visit or procedure not covered by a specific medical code.You must provide detailed explanation why this code is used instead of another existing code to your insurance company.
CPT code 99600 is used to report a home visit service or procedure that does not have a specific code.This code should only be used when no other specific CPT code accurately reflects the service provided.Detailed documentation, including a comparison to similar codes and justification for the billing amount, is required for reimbursement.
Example 1: A home health nurse provides wound care for a patient with a complex pressure ulcer that requires specialized techniques not covered by existing CPT codes., A physical therapist performs a complex rehabilitation session at a patient's home, addressing multiple mobility impairments that are not specifically addressed by routine home health codes., A physician provides an urgent in-home consultation for a patient with a new onset of severe symptoms. This consultation requires a comprehensive evaluation and complex medical decision-making, exceeding the scope of existing home visit codes.
Comprehensive documentation is required, including:*Detailed description of the service(s) provided.*Time spent performing the service(s).*Medical necessity for the service(s).*Comparison to similar CPT codes and explanation of why 99600 is the most appropriate code.*Supporting medical records, such as progress notes or operative reports.
** Accurate and comprehensive documentation is paramount for reimbursement when using code 99600.Payers may require additional information or clarification to justify the service and payment.
- Revenue Code: M4A (Home Visit)
- RVU: Relative Value Units (RVUs) will vary based on the specific service provided and the payer.Documentation supporting the complexity and time spent on the service is crucial to obtaining appropriate reimbursement.
- Global Days: The global period for this code is not defined, as it depends entirely on the specific unlisted service performed.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier depends on the specific unlisted service.Careful consideration must be given to the nature of the service and the provider's role.
- Fee Schedule: Fee schedules for 99600 will vary by payer and are based on the detailed documentation provided.
- Specialties:Multiple specialties may use code 99600, depending on the service provided.Examples include home health nursing, physical therapy, and physician services.
- Place of Service:Home, Assisted Living Facility, Group Home, Custodial Care Facility, Non-traditional Private Homes, Schools