Health Service Code 03.03NB

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

A maximum of one visit per day, per facility, per patient may be claimed.
If a special call for attendance is made for a second visit on the same date of service, a second 03.03NB may be submitted with supporting information.
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.
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.

03.03NB should be used to claim for services provided to the second patient seen in designated assisted living, assisted living, group home or lodge style dwellings that is not a single family home. 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.

Type	Code	# of calls	Explicit	Action	Amount
CMPX	CMGP	1 - 10	Yes	For Each Call Increase By	$19.19

No Governing Rules.