Home Health Services

Policy ID: NDRP-GC-014

Section: General Coding

Effective Date: July 01, 2020

Revised Date: June 16, 2021

Last Reviewed: June 16, 2021

Description

This policy addresses reimbursement for home health services.

Terms	Definitions
Home Health	Care provided to an essentially homebound member in the member’s place of residence.
Intermittent Home Health Services	May include physical therapy, occupational therapy, speech language therapy, skilled nursing, and home health aide services when rendered by a qualified home health provider. A member must receive a skilled service in order to qualify for a home health aide service.
Long Hour Nursing Care	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.

Policy

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.

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

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. 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.

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:

Units	Greater Than	Less Than	Units	Greater Than	Less Than
1	8 Minutes	23 Minutes	5	68 Minutes	83 Minutes
2	23 Minutes	38 Minutes	6	83 Minutes	98 Minutes
3	38 Minutes	53 Minutes	7	98 Minutes	113 Minutes
4	53 Minutes	68 Minutes	8	113 Minutes	128 Minutes

When there is more than one visit per day, bill the appropriate HCPCS code(s) on separate line(s) with the 59 (Distinct procedural service) modifier appended.

The example below shows how to bill for two visits on the same date of service.

FL 42 Rev CD	FL 43 Description	FL 44 HCPCS/Rates	FL 45 Service Date	FL 46 Service Units	FL 47 Total Charges
0551	Skilled Nursing	XXXXX	01012021	3	150.00
0551	Skilled Nursing	XXXXX59	01012021	4	200.00

Long Hour Nursing Care

Long Hour Nursing Care, also referred to as extended hour care, is billed differently than intermittent home health visits. When billing for these types of services, providers should use the HCPCS codes specific to Long Hour Nursing services in the home setting and identify services of either a Registered Nurse (RN) or a Licensed Practical Nurse (LPN).

List of Home Health Codes

Home Health Codes	Home Health Revenue Codes
G0151	42x
G0152	43x
G0153	44x
G0155	56x
G0156	57x
G0157	42x
G0158	43x
G0159	42x
G0160	43x
G0161	44x
G0162	551
G0299	551
G0300	551
G0490	52x
G0493	551
G0494	551
G0495	551
G0496	551
G2168	42x
G2169	43x
S9123	552
S9124	552

Limitations & Exclusions

While reimbursement is considered, payment determination is subject to, but not limited to:

Group or Individual benefit
Provider Participation Agreement
Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
Mandated or legislative required criteria will always supersede.

In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.

Cross References

Home Health- Extended Hours | BCBSND

History

Date	Updates
07/01/2020	Created Home Health Services reimbursement policy
06/16/2021	Added List of home health codes and revenue codes. Updated format and layout.

Disclaimer

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.

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