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Qualifying Criteria for Home Health Services

Home health agencies (HHAs) have numerous regulations to abide by when providing care under the Medicare home health benefit. Knowing the regulations for qualifying criteria for home health is important to avoid survey deficiencies and medical review denials. These regulations are found in the Medicare Benefit Policy ManualExternal PDF(CMS Pub. 100-02), Ch. 7.

The following are basic conditions that must always be met before services provided by a home health agency can be covered by Medicare:

  • The patient is an eligible Medicare beneficiary;
  • The home health agency has a valid agreement to participate in the Medicare program;
  • Medicare is the appropriate payer; and
  • The services billed are not excluded from payment.

Once these conditions are met, the following criteria must also be met:

Reviewed: 12.10.21


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