Medicare post-discharge in-home medication reconciliation billing change

Priority Health covers post-discharge in-home medication reconciliation as a supplemental benefit at no charge for Priority Health Medicare Advantage members who don't qualify for this service under Original Medicare's home health benefit. We are one of the only health insurance companies in Michigan offering this valuable benefit. It's one way we're helping to reduce medication misuse and help our members stay healthy.

Additional revenue code required

Effective July 1, 2018, Priority Health will require an additional billing code on claims for the supplemental post-discharge in-home medication reconciliation service. You'll need to bill two revenue codes:

  • Revenue code 0583 with HCPCS S5109
  • New: Revenue code 1111F (CPT II code)

Charges for the 1111F code should be $0 or $0.01. You will not receive payment for the additional code but you must bill both codes to receive payment for this service.

Questions?

See the Provider Center Drugs section > Post-discharge medication reconciliation, Medicare page, or contact the Priority Health provider Helpline at 800.942.4765 or provider.services@priorityhealth.com with questions about medical reconciliation, how to bill for this service and more.