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Physician Home Visits – Reasonableness of Services

A home visit is when a physician provides evaluation and management (E/M) services in a beneficiary’s home. From January 2013 through December 2015, Medicare provided $718 million in payments for physician home visits.  Physicians are required to document the medical necessity of a home visit in lieu of an office or outpatient visit.  Medicare will not pay for items or services that are not "reasonable and necessary” (SSA § 1862(a)(1)(A)).  We will determine whether Medicare payments to physicians for E/M home visits were reasonable and made in accordance with Medicare requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Physician Home Visits – Reasonableness of Services Office of Audit Services W-00-17-35754 2018

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