Does G0299 require prior authorization?

Yes, G0299 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0299?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0299`, Direct skilled nursing services of a registered nurse (rn) in the home health

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records must fully characterize each behavioral disturbance by documenting: the specific behavior, its frequency, triggers, timing, location, persons involved, alternate explanations (e.g., pain, infection, medication change), consequences, prior successful interventions, and other potential techniques.

The care plan must document that teaching/training interventions were selected based on the behavior assessment, identified impairments and activity limitations, caregiver ability to learn and implement, and environmental factors (WHO ICF recommended).

A physician order for skilled nursing teaching/training is expected (policy scenarios reference physician-ordered skilled nursing); the presence and details of the order should be documented in the medical record.

This article provides billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) L34547; consult LCD L34547 for specific clinical coverage criteria for hospice - neurological conditions.

The provided policy text does not include standalone indications, limitations, frequency limits, or documentation requirements; the referenced LCD (L34547) contains the detailed coverage rules.

Key Coverage Criteria

Home health skilled nursing teaching and training activities are covered for Medicare beneficiaries with dementia and behavioral disturbances when provided as part of a beneficiary-centered care plan to teach family members or caregivers how to manage the behavioral disturbances.
Teaching/training is covered when behavioral disturbances complicate medical management and addressing them is necessary to prevent further deterioration of baseline impairments or activity limitations and to achieve clinically appropriate outcomes.
Teaching/training is covered when interventions are based on a documented, specific characterization of the behavior (what it is, frequency, triggers, timing, location, participants, alternative explanations, consequences, prior successful interventions, and potential techniques).
Teaching/training is covered when interventions are tailored to the beneficiary's specific impairments and activity limitations, the caregiver's ability to learn and implement interventions, and environmental factors (use of WHO ICF is recommended to facilitate documentation).
Coverage for hospice renal care is determined by the Local Coverage Determination (LCD) L34559; refer to LCD L34559 for specific covered diagnoses and clinical criteria for hospice renal services.
Coverage and clinical indications for hospice services for Alzheimer disease and related disorders follow the Local Coverage Determination LCD L34567 and associated clinical criteria therein.

18 Active Policies

ANTHEM-CG-MED-71, Chronic Wound Care in the Home or Outpatient Setting

ANTHEM-CG-MED-23, Home Health

ANTHEM-CG-MED-101, Home Hospice

EVICORE-HPLAN-AETNA-EEDE1D947485, Aetna Home Health Code List - Effective 01/01/2026

A52845, Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances - Medical Policy Article

A56502, Billing and Coding: Hospice - Neurological Conditions

A56545, Billing and Coding: Hospice - Renal Care

A56610, Billing and Coding: Hospice Cardiopulmonary Conditions

A56639, Billing and Coding: Hospice Alzheimer's Disease & Related Disorders

A56641, Billing and Coding: Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances

A56669, Billing and Coding: Hospice - Liver Disease

A56674, Billing and Coding: Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus

A56679, Billing and Coding: Hospice The Adult Failure To Thrive Syndrome

A56756, Billing and Coding: Home Health - Psychiatric Care

AETNA-CPB-0329, Home Births

AETNA-CPB-0541, Dialysis

AETNA-CPB-0201, Skilled Home Health Care Nursing Services

AMBETTER-CP.MP.91, Obstetrical Home Care Programs

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G0299, Direct skilled nursing services of a registered nurse (rn) in the home health