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    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0163-skilled-nursing-observation-home-health-hospice
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    HCPCS G0163: Skilled Nursing Observation and Assessment

    HCPCS Level II code G0163 describes skilled nursing observation and assessment performed by a licensed practical nurse (LPN) or registered nurse (RN) in a home health or hospice setting, reported in 15-minute increments when a change in the patient’s condition requires skilled personnel to identify and evaluate the need for possible modification of treatment; this service is classified as skilled nursing services provided in the home health/hospice site of service and is used to document intermittent skilled observation and clinical reassessment.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A home hospice patient with advanced congestive heart failure (CHF) has increasing shortness of breath, rising peripheral edema, and new confusion overnight. A licensed nurse (RN) is dispatched to the home for skilled assessment. The nurse performs serial 15-minute observation and assessment intervals documenting vital signs, cardiopulmonary auscultation, orthostatic blood pressures, medication adherence review, evaluation for signs of fluid overload or infection, and determination of need for adjustment of diuretics or escalation of care. The nurse communicates findings to the hospice medical director and documents the patient’s response to any in-home interventions. Each 15-minute block of direct skilled observation and assessment is reported using G0163 when the change in condition requires nursing judgment to evaluate potential modification of the plan of care. Typical workflow includes triage by hospice nursing staff, in-home assessment, documentation of medical decision-making supporting skilled need, notification of ordering clinician if treatment modification is indicated, and coordination of follow-up visits or transition to acute care if necessary.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99211Office or other outpatient visit for the evaluation and management of an established patient, typically 5 minutesMay be used for brief non‑physician visits associated with home health assessments when billed by qualified providers; not a replacement for the skilled nursing observation time billed with G0163.
    99406Smoking and tobacco use cessation counseling visit, intermediate, 3–10 minutesExample of a short counseling service that may occur during a home visit; adjunct to skilled assessment but billed separately when applicable.
    99241Office consultation for a new or established patient, typically 15 minutesUsed when a physician consult is performed related to change in condition identified during the skilled nursing assessment that requires a physician-level visit.
    99499Unlisted evaluation and management serviceUsed when an appropriate listed CPT does not describe a non-standard interdisciplinary visit or care coordination activity following nursing assessment; requires supporting documentation.
    99501Home visit for assessment and care planningOften performed in the home-care workflow for interdisciplinary assessment and care planning in conjunction with skilled nursing observation documented by G0163.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    164W00000XLicensed Practical NurseAn individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required f…
    261QP2300XPrimary Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    246ZE0600XElectroneurodiagnostic Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Other
    1223D0004XDental AnesthesiologyA dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years durati…
    163WG0100XGastroenterology Registered NurseNursing Service Providers · Registered Nurse
    246QM0706XMedical TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology
    273100000XEpilepsy Hospital UnitAn Epilepsy Unit is a distinct unit of a hospital that provides services that may include observation, urgent care, diagnostic testing, treatment, and…

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    B20Human immunodeficiency virus [HIV] disease
    D50.9Iron deficiency anemia, unspecified
    E10.9Type 1 diabetes mellitus without complications
    E11.9Type 2 diabetes mellitus without complications
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    G30.9Alzheimer's disease, unspecified
    H66.91Otitis media, unspecified, right ear
    I21.3ST elevation (STEMI) myocardial infarction of unspecified site
    I49.9Cardiac arrhythmia, unspecified

    Showing 1–10 of 28

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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