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Services Not Covered Under Home Health

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §80)External PDF

In addition to the general exclusions from coverage in the Medicare Benefit Policy Manual, (Pub. 100-02, Ch. 16External PDF), the following are also excluded from coverage as home health services:

  • Drugs and biological (except where noted differently)
  • The transportation of a patient
  • Services that would not be covered if furnished as inpatient hospital
  • Housekeeping services for which the sole purpose is to enable the patient to continue residing in their home (e.g., cooking, shopping, Meals on Wheels, cleaning, laundry)
  • Services that are covered under the ESRD program
  • Prosthetic items
    • Note: The Medicare Benefit Policy Manual (Pub. 100-02, Ch. 7, § PDF), states that medical supplies including catheters, catheter supplies, ostomy bags and supplies related to ostomy care furnished by an HHA are specifically excluded from the term "orthotics and prosthetics". These items are bundled while a patient is under a home health plan of care, and an HHA must furnish them to the patient, even if the HHA is not treating a condition/illness requiring these supplies
  • Respiratory services
  • Dietary or nutrition services (If the HHA is performing a complete consult, these services can be included on the Medicare cost report as an administrative cost.)

Updated: 07.30.12

Reviewed: 12.10.21


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