Treating Patients in Nursing Home or Other Facilities

Question: My physicians are considering going to nursing homes and assisted living facilities to do intraocular injections. I know we need to charge a nursing home visit instead of office visit. The place of service would be nursing facility or assisted-living facility. Would Medicare pay for Eylea, Lucentis and Avastin in a nursing facility or assisted living facility or skilled nursing facility? Can we charge a telemedicine visit too?

Answer: Consider several key points:

• Is the facility in lockdown? If yes, so you’ll need approval to enter.
• Regarding the exam, the requirements for modifier -25 have not changed. Although medically necessary, if the established patient exam is performed solely to confirm the need for the injection, then no matter the place of service, the exam is not separately billable. The public health emergency doesn't eliminate this requirement.
• Yes, bill with correct place of service. As many facilities have one wing assisted living another nursing home and another wing skilled nursing facility, confirm place of service for that particular patient within the facility.
• Injected medication is not a covered benefit in a skilled nursing facility, even during this public health emergency. You'll need to use free drug.
• Drugs should be payable in assisted living and nursing home, but to be cautious, consider free drug. If the claim was denied, and appeal lost, you would not be able to bill the patient out-of-pocket.

For more information, go to the Academy’s Telehealth web page.