Health Service Codes

Fee Navigator®

    Health Service Code 03.03NA

    Home visit to patients residing in Assisted Living, Designated Assisted Living (DAL), group homes, seniors lodges or personal care home, first patient

    NOTE:
    1. A maximum of one visit per day, per facility may be claimed. For the subsequent patient seen in the same facility on the same date of service, see HSC 03.03NB.
    2. If a special call for attendance is made for a second visit on the same date of service, a second 03.03NA may be submitted with supporting information.
    3. Modifiers OFEV, OFEVWK, OFNTAM or OFNTPM may only be claimed if a special call for attendance is received and the physician attends within 24 hours of receiving the call.
    4. If the facility provides a room for the physician to see the patient, an appropriate visit (03.02A, 03.03A or 03.04A) should be billed instead.
    5. At a minimum, a physician must complete a limited assessment of a patient's condition requiring a history related to the presenting problems, an examination of the relevant body systems, appropriate records, and advice to the patient.
    Common terms:
    • house call
    • respite care
    Category:V Visit
    Base rate:$87.22

    AMA billing tips:

    • 03.03NA should be used to claim for services provided to those patients that reside facilities such as designated assisted living, assisted living, group home or lodge style dwellings that are not single family homes. For example: an apartment style building (multiple units), where the physician enters into each living unit to complete the visit service. 03.03NA is to be billed for the first patient seen at the complex; the second and subsequent patient in the same complex in the same or different unit is to be billed using 03.03NB.

    • The SUBD modifier MAY ONLY be claimed on home visits when a call for attendance by the physician has been made AND the physician responds on a priority basis within 24 hours of the call. When more than one patient is seen, the appropriate HSC should be used however; additional SUBD modifiers may only be claimed for additional patients when a specific call for attendance has been made for each patient.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SUBDOFEVYesIncrease Base By$43.79
    SUBDOFEVWKYesIncrease Base By$51.33
    SUBDOFNTAMYesIncrease Base By$117.68
    SUBDOFNTPMYesIncrease Base By$117.68
    CMPXCMGP1 - 10YesFor Each Call Increase By$18.84

    Governing Rules:

    No Governing Rules.

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