1 Home Health
REIMBURSEMENT POLICY
Home Health
Active
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Policy Number: General Coding – 030
Policy Title: Home Health
Section: General Coding
Effective Date: 02/16/16
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Description
Home health care is care provided in a patient's home by qualified personnel.
Definitions
Home Health revenue code categories are:
• 055X Home Health (HH) - Skilled Nursing
• 056X Home Health (HH) - Medical Social Services
• 057X Home Health (HH) - Aide
• 058X Home Health (HH) - Other Visits
• 059X Home Health (HH) - Units of Service
• 060X Home Health (HH) – Oxygen
Policy Statement
Home Health
Examples of home health care services requiring review include:
skilled home nursing visits, home health aide services, home social worker visits, physical therapy,
occupational therapy and speech therapy.
• Coverage of services is subject to contract benefits and limitations.
• Services must be skilled versus non-skilled or custodial.
• Services must be intermittent and medically necessary.
• Home health care must be ordered in writing by a physician and performed by a
participating home health agency provider per the member’s contract.
MHCP* (Public Programs) Policy
*MHCP policy takes precedence over the general policy above when processing claims for MHCP
subscribers.
2 Home Health
Elderly Waiver Program
The statewide Elderly Waiver Program (EW) is available to subscribers of Blue Advantage MSC+
and SecureBlueSM (HMO SNP). Blue Plus will review all Medicaid and Medicare home care
requests and determine the number of visits based upon medical necessity, Medicare, and state
plan guidelines. This is applicable to all subscribers receiving Medicaid and Medicare home care
services including those on Elderly Waiver.
Home care agencies contact the member’s care coordinator for consultation regarding the
member’s plan of care. The care coordinator will need to fax in the 6.04.01 Recommendation for
Authorization of MA Home Care Services for subscribers open to a home and community based
disability or form 6.04.03 Home Care Services Recommendation Non-Disability to request Blue
Plus to review the services.
Blue Plus will obtain medical necessity information from the home care agency and will review the
information submitted and make a coverage determination within 10 days of receipt of the request.
When a determination is made, Blue Plus will notify the member and the home care provider via a
letter of the outcome.
Blue Plus will fax the 6.04.01 or 6.04.03 form back to the care coordinator for their records and
case mix cap management.
Minnesota Health Care Programs
Group numbers for subscribers who have coverage with Minnesota Health Care Programs are
as follows:
Product Name
ID #s/Group Numbers
Blue Advantage
(PMAP and MSC+)
MinnesotaCare
Expanded
ID #s begin with “XZG8” / All group
numbers that begin with PP1
SecureBlue
ID #s begin with “XZS8” / All group
numbers that begin with PP2
Documentation Submission
Documentation must identify and describe the services performed including total time of the
service. If a denial is appealed, this documentation must be submitted with the appeal.
Coverage
Eligible services will be subject to the subscriber benefits, Blue Cross fee schedule amount and
The following applies to all claim submissions.
All coding and reimbursement is subject to all terms of the Provider Service Agreement and
subject to changes, updates, or other requirements of coding rules and guidelines. All codes are
subject to federal HIPAA rules, and in the case of medical code sets (HCPCS, CPT, ICD), only
codes valid for the date of service may be submitted or accepted. Reimbursement for all Health
Services is subject to current Blue Cross Medical Policy criteria, policies found in the Provider
3 Home Health
Policy and Procedure Manual sections, Reimbursement Policies and all other provisions of the
Provider Service Agreement (Agreement).
In the event that any new codes are developed during the course of Provider's Agreement, such
new codes will be paid according to the standard or applicable Blue Cross fee schedule until
such time as a new agreement is reached and supersedes the Provider's current Agreement.
All payment for codes based on Relative Value Units (RVU) will include a site of service
differential and will be calculated using the appropriate facility or non-facility components, based
on the site of service identified, as submitted by Provider.
Coding
The following codes are included below for informational purposes only, and are subject to
change without notice. Inclusion or exclusion of a code does not constitute or imply subscriber
coverage or provider reimbursement.
CPT/HCPCS Modifier:
ICD Diagnosis: N/A
ICD Procedure: N/A
HCPCS:
Revenue Codes: N/A
Deleted Codes: N/A
Policy History
Initial Committee Approval Date: February 16, 2016
Code Update: N/A
Policy Review Date: February 16, 2016
May 15, 2018
Cross Reference: N/A
2018 Current Procedural Terminology (CPT
®
) is copyright 2017 American Medical Association. All Rights
Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA
assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to
government use.
Copyright 2018 Blue Cross Blue Shield of Minnesota.
