Note: All CPT/HCPCS codes are subject to change.
Certification for all home health care services is required through the Health Care Management Unit. If you have questions or want to obtain certification, call HCMU at 405-717-8879 or toll-free 800-543-6044, ext. 8879.
Only one per diem per day for each authorized service can be certified.
For example, S9131 (PT, in home, per diem) and S9123 (nursing care, in home, by RN, per diem) can be certified at the same time for corresponding visits because they are different services. However, S9500 and S9501 cannot be certified at the same time because they are both for IV antibiotic therapy. If a patient is getting two antibiotic therapies at two different frequencies (e.g., every 24 hours and every 12 hours), it is up to the provider to determine which IV antibiotic per diem they will bill. IV medications are billed seperately.
As related to reimbursement, per diem represents each day that a patient is provided a prescribed visit. Refer to your current HCPCS codebook for more details regarding specific codes and per diems.
The following HCPCS procedure codes are not covered services:
||Physical therapist in home health or hospice setting; each 15 minutes
||Occupational therapist in home health or hospice setting; each 15 minutes
||Speech/language pathologist in home health or hospice setting; each 15 minutes
||Clinical social worker in home health or hospice setting; each 15 minutes
||Home health or hospice aide in home health or hospice setting; each 15 minutes
||Nurse practitioner visit at member's house, outside of a capitation arrangement
Refer to the CPT/HCPCS fee schedule for covered services.