G0179 — Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a

What the market charges

Across 717 negotiated rates, the middle 80% fall between $34 and $113, with a median of $55.

What Medicare pays

Medicare allowed an average of $40 for this code, across 396,309 services billed by 6,191 providers. At the median, the market charges 1.4 times what Medicare pays for this code.

Where this is billed, and what it costs there

The states billing G0179 most, by Medicare service volume, each compared against the national average of $40. Each links to the providers Mishe lists there.

• California — 597 providers billed it, Medicare allowed $43 — 8% above the national average
• Texas — 1,053 providers billed it, Medicare allowed $39 — 2% below the national average
• Florida — 781 providers billed it, Medicare allowed $39 — 2% below the national average
• Illinois — 290 providers billed it, Medicare allowed $42 — 5% above the national average
• Oklahoma — 280 providers billed it, Medicare allowed $37 — 7% below the national average
• New York — 279 providers billed it, Medicare allowed $46 — 15% above the national average
• Tennessee — 243 providers billed it, Medicare allowed $38 — 5% below the national average
• Louisiana — 272 providers billed it, Medicare allowed $38 — 5% below the national average

Claim-editing rules

These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.

Codes this one absorbs

Billed together, G0179 is the payable code and these are not separately payable. 4 pairs in total.

• 36591 — no modifier can override this edit
• 36592 — no modifier can override this edit
• 96523 — no modifier can override this edit
• G0180 — no modifier can override this edit

Other codes

• J2777 — Injection, faricimab-svoa, 0.1 mg
• J0897 — Injection, denosumab, 1 mg
• J9271 — Injection, pembrolizumab, 1 mg
• J0129 — Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
• G0008 — Administration of influenza virus vaccine
• G0439 — Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
• J9144 — Injection, daratumumab, 10 mg and hyaluronidase-fihj
• J9299 — Injection, nivolumab, 1 mg
• J1745 — Injection, infliximab, excludes biosimilar, 10 mg
• J2357 — Injection, omalizumab, 5 mg

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

• Contact Mishe to learn how to deploy these resources for your team
• Guides to direct-pay healthcare
• Cash prices by procedure
• Find a provider by state

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