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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that providers must report services correctly. Procedures should be reported with the Current 
Procedural Terminology (CPT) code that describes the services performed. You can find this rule in the 
Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual for 
Medicare Services, Chapter I(A). 
 
The rules say that the following data elements are required to submit a claim under home health PPS. For 
billing of home health claims not under an HH plan of care (not under HH PPS), see section 90. Home health 
services under a plan of care are paid based on a 30-day period of care. HHAs submit an NOA at the beginning 
of an admission and then submit one claim for each 30-day period of care. Claims submitted before an NOA 
has been received for the beneficiary will be returned to the provider. Required - On the 0023 revenue code 
line, the HHA may submit the HIPPS code they expect will be used for payment if they choose to run grouping 
software at their site for internal accounting purposes. If not, they may submit any valid HIPPS code in order to 
meet this requirement. HHAs enter only one HIPPS code per claim in all cases. Claims submitted with 
additional HIPPS codes will be returned to the provider. 
 
Medicare will determine the appropriate HIPPS code for payment based on claims and OASIS data and will 
replace the provider-submitted HIPPS code as necessary. If the HIPPS code further changes based on medical 
review or other processes, the code used for payment is recorded in the APC-HIPPS field of the electronic 
claim record. 
 
For revenue code lines other than 0023, the HHA reports HCPCS codes as appropriate to that revenue code. 
 
To report HH visits, the HHA reports one of the following HCPCS codes to represent a visit by each HH care 
discipline HHAs must report where home health services were provided. The following codes are used for this  
reporting: Q5001: Hospice or home health care provided in patient?s home/residence 
Q5002: Hospice or home health care provided in assisted living facility 
Q5009: Hospice or home health care provided in place not otherwise specified 
 
The location where services were provided must always be reported along with the first visit reported on the 
claim. In addition to reporting a visit line using the G codes as described above, HHAs must report an  
additional line item with the same revenue code and date of service, reporting one of the three Q codes (Q5001, 
Q5002, and Q5009), one unit and a nominal covered charge (e.g., a penny). If the location where services were 
provided changes during the period of care, the new location should be reported with an additional line 
corresponding to the first visit provided in the new location. You can find this guidance in the Medicare Claims 
Processing Manual Chapter 10 - Home Health Agency Billing, 40.2 - HH PPS Claims. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.