PA Lookup

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

Home Health Services include medically necessary skilled nursing services, specialized therapies (physical therapy, speech-language pathology, and occupational therapy), home health aide services, and medical supplies provided to a beneficiary in any setting in which normal life activities take place, other than a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities. Home health services may be provided in an intermediate care facility for Individuals with Intellectual Disabilities that are not required to be provided by the facility under subpart I of part 483 or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. Home health services cannot be limited to services furnished to a beneficiary who is homebound in accordance with 42 CFR 440.70.

Unit Value

1 visit

Limits

Skilled nursing is provided on a per-visit basis.

Visits are limited to the amount, frequency, and duration authorized by the attending physician and documented in the plan of care.

Visits must be provided on a part-time or intermittent basis.

Part-time or intermittent means skilled nursing and home health aide services combined total less than 8 hours per day and 28 or fewer hours per week; on a case-by-case basis, the weekly total may be increased up to 35 hours.

Pre-filling insulin syringes/Medi-Planner visits are limited to a maximum of every 2 weeks, with 1 PRN visit allowed each month.

Skilled nursing visits are limited to 75 total visits per beneficiary per year.

If multiple services can be performed during the same visit, they must be completed in only one visit.

Exclusions

Skilled nursing is not covered when: it is not ordered by a physician and included on the authorized plan of care or verbal order; there is no evidence that home health services are the most appropriate setting for the service; documentation in clinical or progress notes does not support that the service was provided in accordance with policy and the plan of care; the service duplicates another provider's service; the service is experimental, investigational, or part of a clinical trial; or the service is related to a terminal illness for a beneficiary who has elected Medicare or Medicaid hospice benefits, although unrelated home health services may still be provided. Home health skilled nursing is not covered on the same day as private duty nursing services. Skilled nursing is also not covered for provision of drug infusion therapy when the beneficiary is receiving services from a Medicaid Home Infusion Therapy provider, though home health skilled nursing may be covered for medical needs unrelated to the drug therapy.

Place of Service

Covered only in settings where normal life activities take place; not in a hospital, nursing facility, ICF/IID except as specified, or any setting where Medicaid inpatient payment including room and board is or could be made.

Additional Service Specifics

The home health agency furnishing the service shall bill for services with its individual NPI. Providers may bill only for those services ordered by a physician and documented in the beneficiary’s individual POC.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 3A
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

Home Health Services include medically necessary skilled nursing services, specialized therapies (physical therapy, speech-language pathology, and occupational therapy), home health aide services, and medical supplies provided to a beneficiary in any setting in which normal life activities take place, other than a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities. Home health services may be provided in an intermediate care facility for Individuals with Intellectual Disabilities that are not required to be provided by the facility under subpart I of part 483 or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. Home health services cannot be limited to services furnished to a beneficiary who is homebound in accordance with 42 CFR 440.70.

Unit Value

1 visit

Limits

Skilled nursing is provided on a per-visit basis.

Visits are limited to the amount, frequency, and duration authorized by the attending physician and documented in the plan of care.

Visits must be provided on a part-time or intermittent basis.

Part-time or intermittent means skilled nursing and home health aide services combined total less than 8 hours per day and 28 or fewer hours per week; on a case-by-case basis, the weekly total may be increased up to 35 hours.

Pre-filling insulin syringes/Medi-Planner visits are limited to a maximum of every 2 weeks, with 1 PRN visit allowed each month.

Skilled nursing visits are limited to 75 total visits per beneficiary per year.

If multiple services can be performed during the same visit, they must be completed in only one visit.

Exclusions

Skilled nursing is not covered when: it is not ordered by a physician and included on the authorized plan of care or verbal order; there is no evidence that home health services are the most appropriate setting for the service; documentation in clinical or progress notes does not support that the service was provided in accordance with policy and the plan of care; the service duplicates another provider's service; the service is experimental, investigational, or part of a clinical trial; or the service is related to a terminal illness for a beneficiary who has elected Medicare or Medicaid hospice benefits, although unrelated home health services may still be provided. Home health skilled nursing is not covered on the same day as private duty nursing services. Skilled nursing is also not covered for provision of drug infusion therapy when the beneficiary is receiving services from a Medicaid Home Infusion Therapy provider, though home health skilled nursing may be covered for medical needs unrelated to the drug therapy.

Place of Service

Covered only in settings where normal life activities take place; not in a hospital, nursing facility, ICF/IID except as specified, or any setting where Medicaid inpatient payment including room and board is or could be made.

Additional Service Specifics

The home health agency furnishing the service shall bill for services with its individual NPI. Providers may bill only for those services ordered by a physician and documented in the beneficiary’s individual POC.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 3A
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

Home Health Services include medically necessary skilled nursing services, specialized therapies (physical therapy, speech-language pathology, and occupational therapy), home health aide services, and medical supplies provided to a beneficiary in any setting in which normal life activities take place, other than a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities. Home health services may be provided in an intermediate care facility for Individuals with Intellectual Disabilities that are not required to be provided by the facility under subpart I of part 483 or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. Home health services cannot be limited to services furnished to a beneficiary who is homebound in accordance with 42 CFR 440.70.

Unit Value

1 visit

Limits

Skilled nursing is provided on a per-visit basis.

Visits are limited to the amount, frequency, and duration authorized by the attending physician and documented in the plan of care.

Visits must be provided on a part-time or intermittent basis.

Part-time or intermittent means skilled nursing and home health aide services combined total less than 8 hours per day and 28 or fewer hours per week; on a case-by-case basis, the weekly total may be increased up to 35 hours.

Pre-filling insulin syringes/Medi-Planner visits are limited to a maximum of every 2 weeks, with 1 PRN visit allowed each month.

Skilled nursing visits are limited to 75 total visits per beneficiary per year.

If multiple services can be performed during the same visit, they must be completed in only one visit.

Exclusions

Skilled nursing is not covered when: it is not ordered by a physician and included on the authorized plan of care or verbal order; there is no evidence that home health services are the most appropriate setting for the service; documentation in clinical or progress notes does not support that the service was provided in accordance with policy and the plan of care; the service duplicates another provider's service; the service is experimental, investigational, or part of a clinical trial; or the service is related to a terminal illness for a beneficiary who has elected Medicare or Medicaid hospice benefits, although unrelated home health services may still be provided. Home health skilled nursing is not covered on the same day as private duty nursing services. Skilled nursing is also not covered for provision of drug infusion therapy when the beneficiary is receiving services from a Medicaid Home Infusion Therapy provider, though home health skilled nursing may be covered for medical needs unrelated to the drug therapy.

Place of Service

Covered only in settings where normal life activities take place; not in a hospital, nursing facility, ICF/IID except as specified, or any setting where Medicaid inpatient payment including room and board is or could be made.

Additional Service Specifics

The home health agency furnishing the service shall bill for services with its individual NPI. Providers may bill only for those services ordered by a physician and documented in the beneficiary’s individual POC.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 3A
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required