Codes for Visits in Assisted Living

Question:

In 2023, how will we code for visits in assisted living?

Answer:

January 1^st 2023, the codes for boarding home, rest home and domiciliary care are gone from the CPT® book. What are the codes for visits in assisted living in 2023 and beyond?

Home and residence services (99341—99345 for new patients) and (99347—99350 for established patients) are used for both settings. The definition of home includes a private residence, temporary lodging or short term accommodation, including hotel, campground, hostel or cruise ship. The codes are also used for people in “assisted living facility, group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), custodial care facility, or residential substance abuse treatment facility.”

A patient in assisted living is reported with these codes.

What about patients in continuing care facilities? These are facilities that include both private apartments, condos and homes and assisted living units with support. CPT® doesn’t talk about continuing care facilities, but these often include both completely independent living (home) and supportive care in assisted living. Since the same set of codes are used, does it matter?

Yes, because you still need to select the correct place of service.  The place of service code for a home visit is 12. The place of service for assisted living is 13.  Both are considered non-facility settings and Medicare pays claims in both settings at the non-facility rate.

Place of service codes

12        Home
13        Assisted living facility
14        Group home
16        Temporary lodging
33        Custodial care facility
55        Residential substance abuse treatment facility

Additional Resources

• Webinar – March 2024 – Home and Nursing Facility Category of Code Rules

AND