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Reimbursement for Physicians

The attending physician is the physician designated by the patient to have the most significant role in his or her care. The attending physician can continue to bill Medicare Part B for professional services - home, inpatient, or nursing home visits -for the non hospice diagnosis with a modifier code, this is independent of the hospice benefit. Medications, laboratory tests, and other non-physician services required for the management of the terminal illness are paid for by the hospice program through the hospice benefit.

Attending physicians can bill for care plan oversight for hospice patients. Payment is available for one physician per month for oversight supervision involving 30 or minutes of the physician's time per month.

Payment under CPT code 99375 encompasses significantly complex medical management requiring the integration of new information into the plan of care or adjustments in medical therapy furnished by the physician. It identifies the coordination of care among practitioners as care plan oversight services. This excludes telephone calls to patients and family members (Federal Register, 1994).

Care plan oversight includes the following physician activities:

  • development / revision of care plans
  • review of subsequent reports of patient status and related laboratory studies
  • coordination and communication (including telephone calls) with other health care professional involved in the patient's care (excluding telephone calls to patients and family members)
  • adjustment and integration of medical treatments