HCPCS code G0180: Home health certification, initial certification, patient not present2026 Medicare rate & RVUs in Massachusetts
A physician or other eligible practitioner initially certifies Medicare home health eligibility and reviews the plan of care without the patient present.
Medicare pays $58.56–$63.97 for G0180 in the office in Massachusetts, from Rest of Massachusetts to Metropolitan Boston, MA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What G0180 covers
G0180 covers the non-face-to-face work of a physician or other eligible practitioner initially certifying a patient for Medicare-covered home health services. The practitioner reviews the proposed plan of care and information from the home health agency, establishes that the patient is homebound and needs qualifying skilled care, and signs the certification. Primary care physicians and hospitalists arranging home health after discharge commonly perform this work; eligible nurse practitioners, clinical nurse specialists, and physician assistants may also certify.
Report G0180 for an initial certification, generally when the patient has received no Medicare home health services in the preceding 60 days. Use G0179 to recertify an ongoing plan for a later certification period. The record should support homebound status and skilled need, include the signed certification and plan of care, and document a qualifying face-to-face encounter within the required window around the start of care. A separately performed face-to-face visit is reported under its own visit code; its work is not the certification service. Keep certification work distinct from any time counted toward monthly home health care plan oversight under G0181.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G0180 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $63.97 | Unavailable |
| Rest of Massachusetts | $58.56 | Unavailable |
How the G0180 rate is calculated
Each of G0180’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0180
RVUs × geographic indexes × conversion factor
Work0.65
0.65 RVUs× 1.000 GPCI
Practice expense1.00
1.00 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.7000
Conversion factor
$33.4009
Medicare rate
$56.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0180
G0180 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G0180
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$56.78
Higher because the practice carries its own overhead.
G0180 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- G0179Home healthRecertification
- G0180 is for initial home health certification; G0179 recertifies an ongoing plan for a later certification period. Do not report both for the same certification period.
- G0181Home health supervision30 minutes per calendar month
- G0181 requires at least 30 minutes of qualifying home health care plan oversight in a calendar month. G0180 is reported for initial certification work, not for accumulated oversight minutes.
- G0162RN plan managementPer 15 minutes
- G0162 describes a home health registered nurse’s management and evaluation of the care plan. G0180 describes the certifying practitioner’s initial Medicare home health certification.
G0180 billing questions
When is G0180 reported instead of G0179?
G0180 is for initial home health certification, generally when the patient has received no Medicare home health services in the preceding 60 days. G0179 is for recertifying an ongoing plan for a subsequent certification period.
Does G0180 include the required face-to-face encounter?
No. Report a separately performed and documented qualifying encounter with the appropriate visit code. G0180 describes the certification work performed without the patient present.
Can G0181 be billed in the same month as G0180?
Yes, when at least 30 minutes of qualifying home health care plan oversight are documented for that calendar month. Do not count G0180 certification work toward those minutes.
Which practitioners can report G0180?
Physicians and eligible nurse practitioners, clinical nurse specialists, and physician assistants may certify Medicare home health services and report G0180 when applicable requirements are met.
What date of service is used for G0180?
Use the date the certifying practitioner completes and signs the initial certification. Retain the signed certification and plan of care in the record.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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