INTERMITTENT NURSING VISITS/AIDE VISITS/THERAPIES Billing Guide

INTERMITTENT NURSING VISITS/AIDE VISITS/THERAPIES

Each visit must be reported on a separate claim line: Medicaid follows Medicare policy on the requirement that each home health agency visit (e.g., nursing, therapy) must be billed on an individual line. This policy includes two visits performed on the same day (i.e., two visits on the same day must be billed on individual lines of the same claim).

Report 15-minute time increments: Medicaid follows Medicare policy for reporting home health visits in 15-minute increments. When billing on the NUBC form, each home health visit revenue code that is reported must have a corresponding 15-minute increment HCPCS code along with the number of15-minute increments reported in the Service Units as follows:

Units Time Requirements

1 1 minute to < 23 minutes

2 23 minutes to < 38 minutes

3 38 minutes to < 53 minutes

4 53 minutes to < 68 minutes

5 68 minutes to < 83 minutes

6 83 minutes to < 98 minutes

7 98 minutes to < 113 minutes

8 113 minutes to < 128 minutes

If services continue for longer periods of time, the home health agency would follow the above pattern. Time of Service Visit: The timing of the visit begins at the beneficiary's home when services actively begin and ends when services are completed. The time counted must be the time spent actively treating the beneficiary. For example:

* If a beneficiary interrupts a treatment to talk on the telephone for other than a minimal amount of time (less than three minutes), then the time the beneficiary spends on the telephone and not engaged in treatment does not count in the amount of service.

* The home health aide completed bathing and transferring the beneficiary into a chair, and now begins to wash the kitchen dishes before leaving. Washing the dishes is considered incidental nd does not meet the definition of a home health aide service. Therefore, the time to perform  this activity would not be included in the 15-minute incremental reporting to Medicaid.


Other nontreatment-related interruptions would follow the same principle. If the beneficiary is late returning home from a doctor’s appointment, the waiting time of the home health agency personnel cannot be counted as treatment time.

However, if the professional spends time with family or other caretakers in the home teaching them to care for the beneficiary, this activity is counted as treatment time. Calls to the physician by the nurse while in the beneficiary’s home to report on the beneficiary’s condition can also be counted as treatment time.