- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
Reporting Home Health Periods with No Skilled Visits
Eligibility for the Medicare HH benefit requires that the beneficiary have a need for intermittent skilled nursing care, PT, SLP, or a continuing need for OT. The need for skilled care makes the patient eligible for other covered HH services (dependent services), i.e., HH aide visits, medical social services, medical supplies, and DME. These services must be billed along with skilled services on the HH claim.
Impact to HHAs
CMS recognizes that there may be circumstances in which the HHA is not able to deliver the skilled services planned for the period of care, e.g., an unexpected inpatient admission. CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 40.1.3 states:
Since the need for "intermittent" skilled nursing care makes the patient eligible for other covered home health services, the Medicare contractor should evaluate each claim involving skilled nursing services furnished less frequently than once every 60 days. In such cases, payment should be made only if documentation justifies a recurring need for reasonable, necessary, and medically predictable skilled nursing services.
Condition code 54 indicates the HHA provided no skilled services during the billing period, but the HHA has documentation on file of an allowable circumstance. HHAs should include condition code 54 on HH final episode claims billed with no skilled services in conjunction with qualifying dependent services. Claims without skilled visits that are submitted without condition code 54 will be returned for correction.
Related Content
- CMS Transmittal 3457; Change Request (CR) 9474
- MLN Matters® Article MM9474: New Condition Code for Reporting Home Health Episodes with No Skilled Visits
Revised 5/23/2024