Reason Code: 55H2B
Error Description:
Documentation submitted does not support homebound status.
Avoiding/Correcting This Error
Ensure the submitted documentation supports the beneficiary is confined to the home.
An individual shall be considered “confined to the home” (homebound) if the following two criteria are met:
- Criterion One: The patient must either: Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence.
OR
Have a condition such that leaving his or her home is medically contraindicated. If the patient meets one of the criterion one conditions, then the patient must ALSO meet two additional requirements defined in criterion two below.
- Criterion Two:
There must exist a normal inability to leave home;
AND
Leaving home must require a considerable and taxing effort.