HOME HEALTH AGENCY (HHA) SERVICES:
The Division of Health Care Financing and Policy (DHCFP) Home Health Agency (HHA) Program is a mandated home health care benefit provided to recipients in his/her residence. HHA services are a component in the continuum of care which allows recipients to remain in his/her home. HHA services may be provided to eligible recipients, based on medical necessity, program criteria, utilization control measures and the availability of the state’ resources to meet recipient needs. HHA services are provided on an intermittent basis, certified by a physician and provided under a physician approved Plan of Care (POC). The Home Health Agency (HHA) service benefit provides Skilled Nursing (SN) services, and other therapeutic services such as Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), and Home Health Aides or Certified Nursing Aides (CNAs). Respiratory Therapists (RT) and Registered Dieticians (RD) are also a benefit with limitations. Services are generally provided on a short-term basis as opposed to longterm custodial services.
Home Health CPT CODES
99500 Home visit for prenatal monitoring and assessment to include fetal heart rate, non-stress test, uterine monitoring, and gestational diabetesmonitoring
99501 Home visit for postnatal assessment and follow-up care
99502 Home visit for newborn care and assessment
99503 Home visit for respiratory therapy care (e.g., bronchodilator,oxygentherapy,respiratoryassessment, apnea evaluation)
99504 Home visit for mechanical ventilation care
99505 Home visit for stoma care and maintenance including colostomy and cystostomy
99506 Home visit for intramuscular injections
99507 Home visit for care and maintenance of catheter(s) (e.g., urinary, drainage, and enteral)
99511 Home visit for fecal impaction management and enema administration
99512 Home visit for hemodialysis
T1001 RN Nurse Assessment
T1030 Nursing care, in the home, by RN, per diem
T1002 RN Skilled Nurse services, per 15 min
T1002.TT RN Skilled Nurse services shared 1:2 ratio; per 15 min
S9123 Extended Nursing care in the home by RN, per hour
T1031 Nursing care, in the home, by LPN, per diem
T1003 LPN Skilled Nurse services, PER 15 MIN
T1003.TT LPN Skilled Nurse services shared 1:2 ratio; per 15 min
S9124 Extended Nursing care in the home by LPN, per hour
T1002.TG RN services, up to 15 minutes, complex/high tech level of care
T1003.TG LPN services, up to 15 minutes, complex/high tech level of care
T1021 Home Health aide or CNA, per visit
T1004 / G0156 Services of qualified nursing aide (HHA), per 15 min
99501 Home Visit Postnatal Assessment /Follow Up Care
99502 Home Visit for Newborn Care and Assessment
92506 ST Assessment
S9128 ST, in the home, per diem
S5180 RT Assessment
S5181 RT VISIT
97001 PT Assessment
S9131 PT, in the home, per diem
97003 OT Assessment
S9129 OT, in the home, per diem
S9127 Social Work Visit, in the home, per diem
a. Skilled nursing services provided by a licensed nurse performing skilled interventions to maintain or improve the recipient’s health status.
b. Physical therapy services provided by a licensed physical therapist to restore, maintain or improve muscle tone, joint mobility or physical function.
c. Occupational therapy services provided by a licensed occupational therapist to improve or restore function.
d. Speech therapy provided by a licensed speech pathologist for the treatment of speech and language disorders, communicative disabilities or swallowing disorders.
e. Respiratory therapy provided by a licensed respiratory therapist
f. Dietician services provided by a registered dietician for consultative services for nutritional deficits or recipients at risk of nutritional deficits.
g. Home Health Aide services provided by a Certified Nursing Aide (CNA) under the supervision of a registered nurse and in accordance with the Nurse Practice Act.
Description of Services
Home health care services are short-term services, prescribed by treating practitioner or specialist (M.D., D.O., P.A. or N.P) delivered within a health plan member’s residence and are designed to help a member recover after an illness, injury, hospital stay, or surgery, or to help manage a chronic condition with the goal of preventing an unplanned hospitalization or prolonging a current hospitalization. Home health care services are provided intermittently to restore or maintain a member’s maximal level of function and health in lieu of receiving the services in an outpatient setting or in an acute or sub-acute health care setting. Skilled care services are medically necessary services provided in the member’s Place Of Residence by licensed health care professionals and may include services such as medical or psychological evaluation, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Custodial care services are non-medical services that provide assistance with personal care such as activities of daily living,
housekeeping, cooking, laundry or supervision of self-administered medication that can reasonably and safely be provided by non-licensed caregivers.
HOME HEALTH AGENCY VISITS
a. Evaluation visit
HHA’s are required to have written policies concerning the acceptance of the recipient by the agency. This includes consideration of the physical facility available in the recipient’s place of residence, homebound status and the attitudes of family members for the purpose of evaluating the feasibility of meeting the recipient’s medical needs in the home health setting. When personnel of the HHA make an initial visit to assess the recipient the cost of the visit is considered an administrative cost and is not reimbursable as a visit at this point since the recipient has not been accepted for care. If during the course of the initial visit, the recipient is determined appropriate for home health care by the agency and the recipient received the first skilled service as ordered under the POC, the visit becomes the first billable visit as an RN extended visit.
b. Supervisory visit
A supervisory visit made by a registered nurse to complete a recertification visit or to evaluate the delivery of specific needs of the recipient by a CNA or LPN can be authorized only once every 60-62 days. This is authorized as a RN extended visit.
c. Visit types
Two types of visits may be provided under skilled nursing. These are: An extended visit, which is defined as any visit exceeding 30 minutes but not more than 90 minutes; and the nurse’s brief visit, which is defined as a visit of 30 minutes or less. Visits for certified nursing aides are approved for the first hour and each additional ½ hour thereafter.