12/28/2022

Correct Coding for Assisted Living

To Whom it May Concern: Will both Regular Medicare & Medicare Advantage plans continue to accept the assisted living EM codes in 2023 (initial visit 99324 & 99325, f/u visit 99334 & 99335?) If not, what would be the appropriate code for an EM visit? We have heard possibly that house-call codes be used (initial visit 99342 & 99343; f/u visit 99347 & 99348? Does the initial visit code 99343 still exist?) With Regular Medicare, billing a 99343 or 99348 generally results in a prepayment audit. Will that remain the same if these codes are used in the assisted living place of service? (That would result in a significantly increased number of prepaid audits due to the relatively low number of house calls compared with the number of assisted living visits.) Finally, is the assisted place of service code remaining even if the EM codes change? Thank you in advance for your time & consideration in answering these questions.

For service dates on or after January 1st, home visit E&M codes (CPT codes 99341-99350) should be reported to all payers. This includes not only traditional Medicare, but all Medicare Advantage plans and commercial payers. When billing these codes, the POS code will reflect if the patient was seen in a private residence (12) or an assisted living facility (13). In term of prepayment audits, we cannot reasonably predict if these will continue when the coding changes go into effect for 2023 with Medicare and other payers. We will only be able to provide input based on claims that are submitted in the new year or if NGS sends out notification to part B providers that specific home visit codes will be subject to a pre-payment audit.