This policy addresses reimbursement for home health services.
Home health is care provided to an essentially homebound member in the member’s place of residence.
Home health services may include skilled services (physical therapy, occupational therapy, speech language therapy and skilled nursing) and home health aide services. A member must receive a skilled service in order to qualify for a home health aide service.
Long Hour Nursing care is a separate level of service provided when a skilled nursing visit exceeds two hours in length. Examples may include intravenous (IV) infusion greater than two hours requiring constant supervision by a nurse or nursing care to a ventilator dependent child or adult. When a home care skilled nursing visit is two hours or less, intermittent visit codes should be used.
Home health is considered an institutional service and should be submitted on the UB-04 claim form with Type of Bill:
- 032X – Home Health Services under a plan of treatment
- 034X – Home Health Services not under a plan of treatment
The Healthcare Common Procedure Coding System (HCPCS) G codes identify intermittent home health services. These codes are specific to physical therapy, occupational therapy, speech language therapy, skilled nursing, and home health aide services when rendered by a qualified home health provider.
Services performed by a physical therapy assistant or an occupational therapy assistant will be covered at a percentage of the physical and occupational therapy code reimbursement rate.
Based on the code definitions, one unit equals 15 minutes. Each visit should be reported based on the length of time of the service. The time reported must be time actively spent treating the member at his/her place of residence. Time used for travel or administrative services cannot be included in the amount of time reported for the visit. Chart notes must include documentation of time spent during the visit.
Blue Cross Blue Shield of North Dakota (BCBSND) reimburses the first 15-minute increment of a visit at two times the single 15-minute increment. Each additional unit will be allowed at the single 15-minute increment. This applies only to intermittent home health services and does not apply to Long Hour Nursing services.
When counting the number of 15-minute intervals, do not report services lasting less than 8 minutes. Time intervals for larger numbers of units are as follows: