HCPCS code G0164 – Skilled nursing training and education in the home health or hospice setting

Key takeaways

HCPCS code G0164 covered skilled nurse training and education of a patient or family member, performed by an LPN or an RN, in 15-minute units.

CMS deleted G0164 effective January 1, 2017, and Medicare stopped accepting it on home health claims for visits from that date.

Training and education visits now take G0495 when an RN performs them and G0496 when an LPN does, still billed per 15 minutes.

G0162 is a separate RN-only code for managing and evaluating the plan of care, so it was never the RN version of G0164.

Hospices report every nursing visit, training included, with G0299 for an RN or G0300 for an LPN instead of G0495 or G0496.

What is HCPCS code G0164?

HCPCS code G0164 is a deleted Medicare G-code for skilled nurse training and education of a patient or family member, billed per 15 minutes. Either a licensed practical nurse (LPN) or a registered nurse (RN) could perform the service, in the home health or hospice setting.

CMS deleted the code effective January 1, 2017, through Change Request 9736. Training and education visits dated on or after that day are billed with G0495 when an RN performs them, or G0496 when an LPN does.

Who could bill G0164

Home health agencies (HHAs) reported G0164 on their Medicare home health claims, under a skilled nursing revenue line in the 055x range. Each line carried the date of service and the number of 15-minute units the visit took. Payment came through the home health prospective payment system, so the agency billed the visit as part of the patient’s episode of care. For the wider claim cycle, see this guide to medical billing fundamentals.

The descriptor also named the hospice setting. Hospice claims, though, report skilled nursing visits with their own pair of codes, covered in the billing section below.

HCPCS code G0164 quick reference

Use this table to check a historical G0164 line or to route a training visit to its current code.

Why CMS deleted G0164

CMS deleted G0164 because the code could not show whether an RN or an LPN made the visit. CMS needed that split to cost each home health episode precisely.

CMS recalibrates the home health case-mix weights every year. To do it, CMS prices each episode with the Bureau of Labor Statistics hourly wage for the discipline that made each visit. That wage is then multiplied by the minutes reported on the claim.

Therapy already had separate codes for therapists and assistants, so their visits were priced at the right wage. For G0163 and G0164, CMS had to assume what share of visits came from RNs versus LPNs.

A year earlier, CMS had split direct skilled nursing (G0154) into G0299 for RNs and G0300 for LPNs. Change Request 9736 applied the same logic to observation and assessment (G0163) and to training and education (G0164). CMS described the goal as removing the assumption and increasing payment precision.

The same change request moved home health outlier payments to a cost-per-unit method based on 15-minute units. That made the reported time on every nursing line count for more than it had before.

What replaced G0164: G0495 and G0496

G0495 and G0496 replaced G0164 for visits on or after January 1, 2017. The service and unit stayed the same, and the code now records the nurse’s license.

The Medicare Claims Processing Manual, chapter 10 still lists G0495 and G0496 under “Training” in the skilled nursing revenue code range. Both describe skilled services in the training and/or education of a patient or family member, each 15 minutes.

Observation and assessment changed at the same time. G0163 was deleted on the same date and replaced by G0493 (RN) and G0494 (LPN).

How to bill patient or family training and education now

Bill a training or education visit by the setting first, then by the license of the nurse who did the teaching. The decision tree below puts the date of service ahead of both, since it settles whether G0164 can appear at all.

Home health agency claims

An HHA reports a nurse training visit with G0495 or G0496 on its institutional claim. That claim goes out as the electronic 837I, or as the paper UB-04 (CMS-1450) for agencies exempt from electronic filing.

• Put the visit on its own line under a skilled nursing revenue code in the 055x range. CMS’s own claim examples use 0551.
• Report G0495 if an RN did the teaching, or G0496 if an LPN did.
• Enter the line item date of service and a charge.
• Report units as the number of 15-minute increments the visit took.

Each visit line carries one skilled nursing G-code. Choose the code that describes the main purpose of the visit, and let the visit note show why.

Medicare pays home health in 30-day periods, not per visit. The visit lines and their units still need to be complete and accurate, because CMS uses that data in its payment calculations.

Hospice claims

Hospices do not use G0495 or G0496. The hospice claims chapter tells hospices to report skilled nursing visits under revenue code 055x with G0299 for an RN or G0300 for an LPN.

A hospice nurse who teaches a family member to manage pain medication is reported the same way as any other nursing visit. Visit lines on a hospice claim are bundled into the payment for the level of care, so they earn no separate payment.

Coverage conditions that still apply

The replacement codes did not change who qualifies for home health. Under the Medicare Benefit Policy Manual, chapter 7, the patient must be homebound and under a plan of care.

• Homebound status: The patient needs help, a device, or special transportation to leave home, or leaving is medically contraindicated. The patient also has a normal inability to leave home, and leaving takes a considerable and taxing effort.
• Plan of care: A physician or allowed practitioner certifies the plan, which orders the skilled nursing and its frequency. Older paperwork calls this form the CMS-485, and many agencies still say “the 485”.
• Skilled need: The teaching must need a nurse’s skills, not a caregiver repeating instructions they already know.

Home health consolidated billing also applies. While a patient is under a home health plan of care, the HHA bills the covered home health services for that period. Confirming who bills each visit belongs in any medical billing compliance routine.

Documentation for a training and education visit

The visit note decides which code the line can carry. An auditor reading the note alone should see who taught, what was taught, and why it needed a nurse.

G0164 vs. G0162, G0299, G0300 and G0493 to G0496

The home health nursing G-codes split by purpose first and license second. G0162 is the one code with no LPN counterpart.

G0162 covers an RN managing and evaluating the plan of care when non-skilled care needs RN oversight to work. It does not describe teaching, so it never stood in for G0164.

G0299 and G0300 cover hands-on skilled nursing, such as a dressing change. In home health, a visit spent mainly on teaching goes to G0495 or G0496 instead.

Common errors when billing nurse training after G0164

Training-visit errors often trace back to old templates or crosswalks that still point at G0164. Fixing the source stops the same error repeating, which is the core of denial management. For the reason codes on a returned claim, see this guide to medical billing denial codes.

How Pabau keeps training visit notes ready for coding

Coding a training visit correctly depends on the note. The coder needs the nurse’s license, the visit time, and what was taught, all in one record.

Pabau, the medical billing software and practice platform we build, holds treatment notes, digital forms, and patient records in one place. A visit form can ask for the learner, the skill taught, and time in and time out. The nurse completes it before the note is signed.

Pabau Scribe, our AI scribe, drafts the visit note from the conversation, so the nurse spends less time typing. Your billing team then codes from a signed note instead of chasing the nurse for details.

Capture complete notes for every nursing visit

Pabau’s treatment notes and digital forms record who taught, what was taught, and for how long. Your billing team codes each visit from a complete record.

Book a demo

Conclusion

G0164 belongs to 2016 and earlier. Any template, charge master, or crosswalk that still offers it will keep producing rejected lines, so retire it at the source.

From there, the coding decision is short. In home health, the nurse’s license picks G0495 or G0496. In hospice, the visit goes to G0299 or G0300. The note has to prove the teaching needed a nurse, whichever code applies.

Book a demo to see how Pabau keeps nursing visit notes complete before your team codes them.

Continue your research

Need to code a nurse observation and assessment visit? HCPCS code G0163 explains the deleted observation and assessment code and its G0493 and G0494 replacements.

Billing an RN for plan-of-care oversight? HCPCS code G0162 covers when RN management and evaluation of the plan of care applies.

Coding a hands-on RN nursing visit? HCPCS code G0299 walks through direct skilled nursing by an RN, units, and documentation.

Want a primer on clean claim requirements before your next review? Medical billing compliance outlines the documentation and submission standards behind clean Medicare claims.

Looking for the reason codes Medicare returns on rejected claims? Denial codes in medical billing maps common denial codes to their causes and fixes.

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