G0180

Initial physician or allowed practitioner certification for Medicare-covered home health services, performed without the patient present, including HHA contact and plan-of-care review.

Verified May 8, 2026 · 5 sources ↓

Medicare: $56.78
Total RVUs: 1.7
Global, days
Region: General

Drawn from CMSNovitasCgmAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Signed and dated plan of care (CMS 485 or equivalent) with the physician's signature date used as the date of service
If the HHA prepared the plan, a note documenting the physician's specific review of or contribution to each element of the plan
Evidence of contact with the home health agency and review of patient status reports
Documentation confirming all five Medicare home health certification requirements are met per CMS IOM Pub. 100-08, Chapter 6, Section 6.2.1.1
HHA provider number recorded in Item 23 of the CMS-1500 or electronic equivalent
Medical record entry showing the physician affirmed the plan meets the patient's current needs

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 52 Reduced services

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

G0180 is billed when a physician or allowed practitioner certifies a patient's eligibility for Medicare home health services and signs off on the initial plan of care. The work is done without the patient present — it covers reviewing HHA-submitted reports, communicating with the home health agency, and affirming that the plan of care meets the patient's needs for that certification period.

This is a Part B physician claim paid under the Physician Fee Schedule. The date of service is the date the physician completes and signs the plan of care — not the date home health services start. The HHA's provider number must appear in Item 23 of the CMS-1500. If the HHA prepared the written plan, the medical record must document the physician's specific contribution to or review of that plan.

G0180 is explicitly excluded from the global surgical package. Bill it during an active global period without modifier 24 — it stands on its own. Use G0179 for subsequent recertifications after the first 60-day episode. G0180 and G0179 are not covered if the underlying HHA claim was denied for incomplete certification or insufficient eligibility documentation.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.65
Practice expense RVU	1
Malpractice RVU	0.05
Total RVU	1.7
Medicare national rate	$56.78
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$56.78

Common denial reasons

The recurring reasons claims for CPT G0180 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

HHA claim denied for incomplete or missing certification — G0180 cannot be paid if the underlying home health claim is non-covered
Date of service entered as the start of home health services rather than the date the physician signed the plan of care
Missing HHA provider number in Item 23 of the CMS-1500
No documented physician contribution when the plan was prepared by the HHA rather than the physician
G0180 billed for a recertification period — use G0179 for episodes after the initial certification

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can G0180 be billed during a global surgical period?

Yes. G0180 is explicitly excluded from the global surgical package per Novitas guidance. Bill it without modifier 24 — no workaround needed.

02What is the date of service for G0180?

The date the physician completes and signs the plan of care. Do not use the date home health services begin — claims submitted with the wrong date of service will be denied.

03Which code covers recertification after the first 60-day episode?

G0179. G0180 is for the initial certification only. Billing G0180 for a recertification period is a coding error and will result in denial or recoupment.

04Do commercial payers reimburse G0180?

Some do, but G0180 is a Medicare-specific HCPCS code with no direct CPT equivalent. Commercial coverage is payer-variable — verify eligibility before billing.

05What happens if the HHA prepared the plan of care instead of the physician?

The physician's medical record must document their specific contribution to or review of the plan's individual elements. A generic 'reviewed and signed' note is an audit risk and can support a non-coverage finding.

06Can an orthopedic surgeon bill G0180?

Yes. Orthopedic Surgery appears in the top billing specialties for G0180 in CMS PUF data. Any physician who certifies a Medicare home health patient and meets the 42 CFR 424.22 requirements may bill it.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the physician's attestation language, the date of plan-of-care review, the HHA name and provider number, and any documented contact with the agency — the specific elements auditors check when the underlying HHA claim is pulled. Missing or generic attestation language is the leading reason G0180 claims are recouped on post-payment review.

See how Mira captures CPT G0180 documentation