New Code Allows Home Health Claims Without Skilled Services

A new condition code will allow home health claims for subsequent episodes to process even when skilled nursing services aren’t involved, according to the Centers for Medicare & Medicaid Services (CMS).

Currently, home health claims submitted without skilled nursing visits are automatically returned to the provider, as are claims that are the first in a series of episodes or are the only episode. With the new condition code, which CMS will implement on July 1, claims for subsequent episodes will be accepted and processed.

Home health agencies sometimes encounter situations where they can’t deliver the skilled services planned for a subsequent episode, like an unexpected inpatient admission, but figuring out payment from there requires the agency to submit supporting documentation to the Medicare Administrative Contractor for review. The new condition code would remove the step for additional documentation.


Claims submitted without the new code will be returned to the provider, allowing the home health agency to then make changes to add skilled services to the claim if they were omitted, submit the claim as non-covered, if appropriate, or include the new condition code.

“These actions will prevent unnecessary reviews and denials for the [home health agency] and allow Medicare to better target medical review resources,” the National Association for Home Care & Hospice states.

Written by Kourtney Liepelt


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