Questions billers ask › How does Medicare handle home health agency billing?
How does Medicare handle home health agency billing?
The rule, word for word
“ICD-10, Implementation: 09-23-14; ICD-10: Upon Implementation of ICD-10) This chapter, in general, describes billing and claims processing requirements that are applicable only to home health agencies. For general bill processing requirements refer to the appropriate other chapters in the Medicare Claims Processing Manual. For a description of home health coverage policies see Pub. 100-02, Medicare Benefit Policy Manual, chapter 7. A. Where and How to Bill Institutional providers, including home health agencies, use one of two institutional claim formats to bill Original Medicare. In the great majority of cases, these providers are required to use the electronic HIPAA standard institutional claim transaction, the 837 institutional claim. The minority of providers that are eligible for an exception to electronic claim submission use the paper Form CMS-1450, also known as the UB-04. Such claim forms are submitted to certain Medicare Administrative Contractors (A/B MACs (HHH)) with jurisdiction over home health and hospice claims. Some home health agencies may also become approved as Durable Medical Equipment (DME) suppliers, in which case they would submit bills for DMEPOS services to the DME MACs on a professional claim format (the 837professional or paper Form CMS-1500). References to the claim form in this chapter refer to the paper Form CMS-1450 unless otherwise noted. [...]”
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What our AI found in the sources
Home health agencies (HHAs) bill Medicare using the electronic 837 institutional claim transaction or, if eligible for an exception, the paper Form CMS-1450 (UB-04), submitted to Medicare Administrative Contractors (A/B MACs) with jurisdiction over home health claims. Under the Home Health Prospective Payment System (HH PPS), Medicare pays HHAs a predetermined base payment for each covered 60-day episode of care, adjusted for the patient's health condition, care needs, and geographic wage differences. The HHA must bill for all services under the home health plan of care--including skilled nursing, therapy, home health aide services, medical social services, and routine and nonroutine medical supplies--in a single consolidated bill; these services are included in the episode payment. Durable medical equipment (DME) is exempt from consolidated billing by law and may be billed separately by the HHA or a DME supplier.
Also cited
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Captured2026-05-24
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If this comes up on one of your claims
The quoted paragraph above is what you would put in the appeal or the audit file, with its citation and dates. Verbatim does not tell you how to bill; it shows you the rule as published so the decision is yours and the proof is in writing.
Ask it your own question and get the same thing back: the governing rule, quoted, with a citation that still verifies later.
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