Home Health Coverage Guidelines
Medicare Benefit Policy Manual, (CMS Publication 100-02, Ch. 7)
Medicare pays for care in a beneficiary's home, when qualifying criteria are met, and documented. It is essential for home health agencies to have a complete understanding of these criteria, as you have the right and responsibility, in collaboration with the physician, to decide if the beneficiary qualifies for your services. The agency then must understand what services are covered, and how to document these services. Refer to the following topics for more information:
- Qualifying Criteria for Home Health Services
Medicare-Covered Home Health Services
- Defining "Visits"
- Home Health Aide
- Medical Social Worker
- Occupational Therapy
- Outpatient Therapies
- Physical Therapy
- Skilled Nursing
- Speech-Language Pathology
- Services Not Covered in Home Health
- Supplies
Additional Resources
- Advance Beneficiary Notice of Noncoverage (ABN)
- CGS Home Health Patient-Driven Groupings Model (PDGM)
- CMS Home Health Patient-Driven Groupings Model (PDGM)
- Expedited Determination Process
- Home Health Agency Requirements
- Home Health Change of Care Notice (HHCCN)
- Home Health Prospective Payment System (HH PPS) Overview
- Home Health Quality Reporting Requirements
- Providing Care Under Arrangement with Other Organizations
- Home Health Clinical FAQs
- Home Health Face-To-Face (FTF) FAQs
- Home Health Quick Resource Tools
Home Health Payment Rates
- Calendar Year 2021 Rates by County
- Calendar Year 2021 Rates
- Calendar Year 2020 Rates by County
- Calendar Year 2020 Rates
- Calendar year 2019 Rates by County
- Calendar Year 2019 Rates
- Calendar Year 2018 Rates by County
- Calendar Year 2018 Rates
- Calendar Year 2017 Rates by County
- Calendar Year 2017 Rates
- Consolidated Billing Master Supply List
Updated: 11.30.21