2025 HCPCS code G2007
Limited (30 minutes) in-home visit for an existing patient post-discharge in a Medicare-approved CMMI model.
Medical necessity is established by the patient's condition and need for post-discharge follow-up within the CMMI model. The documentation must support that the home visit was necessary for managing the patient's condition and preventing complications or rehospitalization.
The provider, enrolled in a CMMI model, is responsible for seeing and evaluating the patient, conducting a focused history and physical exam, making low-complexity medical decisions, assessing the patient's functional abilities, reviewing medications, checking treatment adherence, educating the patient, and coordinating care with other healthcare professionals involved in the patient's care.
In simple words: This code represents a short home visit by a healthcare professional after you leave the hospital. It's part of a special Medicare program to improve care and must be done within 90 days of leaving the hospital.
This code covers a limited, approximately 30-minute, in-home visit for an established patient within 90 days of discharge from an inpatient hospital facility, provided by a practitioner enrolled in a Medicare-approved Center for Medicare and Medicaid Innovation (CMMI) model. The visit can occur in various settings, including the patient's home, domiciliary, rest home, assisted living facility (ALF), or skilled nursing facility (SNF). Services typically involve a focused history and physical exam, low-complexity decision-making, assessment of functional status, medication review, adherence assessment, patient education, communication with other clinicians, and care management to connect the patient with community resources.
Example 1: A patient is discharged home after a heart attack. A nurse practitioner enrolled in a CMMI model visits the patient at home within a week of discharge to assess their recovery, review medications, and educate them on lifestyle modifications., An elderly patient is discharged from the hospital to a skilled nursing facility following a hip replacement. A physician enrolled in a CMMI model visits the patient at the SNF to monitor their progress, assess pain management, and coordinate care with the SNF staff., A patient with diabetes is discharged home after a hospital stay for uncontrolled blood sugar. A physician assistant enrolled in a CMMI model makes a home visit to review the patient's insulin regimen, assess their understanding of diabetes management, and connect them with local resources for diabetes support.
Documentation should support the medical necessity of the home visit, including the patient's discharge status, current condition, reason for the visit, services provided, time spent with the patient, and the provider's assessment and plan of care. It should also clearly indicate that the provider is enrolled in an approved CMMI model.
- Payment Status: Active
- Specialties:Various specialties can utilize this code, depending on the CMMI model and the patient's condition. This may include physicians, nurse practitioners, physician assistants, and other qualified healthcare professionals involved in post-discharge care.
- Place of Service:Home, Assisted Living Facility, Skilled Nursing Facility