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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.  

Medicare guidance says, Physicians must report services correctly. This manual discusses general coding principles in Chapter I and principles more relevant to other specific groups of HCPCS/CPT codes in the other chapters. There are certain types of improper coding that physicians must avoid. You can find this guidance in the Chapter 1 General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services, A. Introduction.  

Medicare guidance says, 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 837 professional or paper Form CMS-1500). 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: Skilled Nursing (revenue code 055x) - General skilled nursing: G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting. Regarding all skilled nursing and skilled therapy visits-  

In the course of a single visit, a nurse or qualified therapist may provide more than one of the nursing or therapy services reflected in the codes above. HHAs must not report more than one G-code for each visit regardless of the variety of services provided during the visit. In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G-code which reflects the service for which the clinician spent most of his/her time. For episodes beginning on or after July 1, 2013, 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 episode, the new location should be reported with an additional line corresponding to the first visit provided in the new location. Required - For initial episodes, the HHA reports on the 0023 revenue code line the date of the first covered visit provided during the episode. For subsequent episodes, the HHA reports on the 0023 revenue code the date of the first visit provided during the episode line, regardless of whether the visit was covered or non-covered. You can find this guidance in the Medicare Claims Processing Manual Chapter 10 - Home Health Agency Billing, 10 - General Guidelines for Processing Home Health Agency (HHA) Claims, 40.2 - HH PPS Claims.  

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.