(Medicare Claims Processing Manual)

The HHA reports the HCPCS code with one of three revenue codes, depending on the practitioner that provided the service:    Skilled nurse  0559   Physical therapist  042x   Occupational therapy  043x.  When using revenue codes 042x or 043x, the HHA should not use the therapy plan of care modifiers (GO or GP) for NPWT services.   These HCPCS codes include payment for both performing the service and the disposable NPWT device, which is defined as an integrated system comprised of a nonmanual vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of wound therapy.  Services related to the provision of NPWT using a disposable device that do not encompass the provision of the entire integrated system should be billed per existing HH PPS guidelines.  To avoid duplication of payment, for instances where the sole purpose for an HHA visit is to perform NPWT using a disposable device, Medicare will not pay for a skilled nursing or therapy visit under the HH PPS. Rather, performing NPWT using a disposable device for a patient under a home health plan of care is be separately reimbursed the OPPS amount. In this situation, the HHA bills only under TOB 034x.  This visit is not reported on the HH PPS claim (TOB 032x).   If NPWT using a disposable device is performed during the course of an otherwise covered home health visit (e.g., to perform a catheter change), the visit would be covered as normal.  Performing NPWT using a disposable device will be separately reimbursed the OPPS amount. In this situation, the HHA bills under TOB 034X and this visit is also reported on the HH PPS claim (TOB 032x).  The HHA must not include the time spent performing NPWT in their visit charge or in the length of time reported for the visit on the HH PPS claim.   100 - Temporary Suspension of Home Health Services  (Rev. 10758; Issued: 05- 11-21; Effective: 01 -01-22; Implementation: 08 -11-21)  A physician may suspend visits for a time to determine whether the patient has recovered sufficiently to do without further home health services.  When the suspension is temporary (does not extend beyond the end date of the 60- day certification period) and the physician later determines that the services must be resumed, the resumed services are paid as part of the same or subsequent 30- day period of care and under the same plan of care as before.  The admission date remains the same on any claims.  No special indication need be made on the claim(s) for the period of suspended services.  Explanation of the suspension need be indicated only in the medical record.  If the suspension extends beyond the end of the current 60- day certification, HHAs must submit a discharge claim.  Full payment will be due for the period of care.  If the beneficiary resumes care, the HHA must establish a new plan of care and submit an NO A for a new admission.    110 - Billing and Payment Procedures Regarding Ownership and CMS Certification Numbers (CCNs)  (Rev.  2977, Issued; 06- 20-14, Effective: 09 -23-14; ICD- 10: Upon Implementation of ICD- 10, Implementation: 09 -23-14; ICD -10: Upon Implementation of ICD -10)  110.1  RESERVED  (Rev. 4378, Issued:  08- 23-19, Effective: 01 -01-20, Implementation: 11-  27-19)   110.2 - Payment Procedures for Terminated HHAs  (Rev. 10758; Issued: 05- 11-21; Effective: 01 -01-22; Implementation: 08 -11-21)  Medicare regulations allow that payment may be made for home health services for up to thirty days after a home health agency (HHA) terminates their Medicare provider agreement.  This payment may be made if the home health services are furnished under a home health plan of care establish ed before the effective date of the termination.   Medicare continues to make full period of care payments for periods which extend beyond a providers termination date if the home health services are provided under a plan of care established prior to that date and if the home health period of care ends within the 30 day period.          Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR# R12382CP  11/28/2023 Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Prospective Payment System Claims -   01/02/2024 13244 R12306CP  10/19/2023 Processing Claims When the Dates of Service Are Beyond the Time Limit for the Patient Assessment   01/24/2024 13402 R12291CP   10/05/2023 Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Prospective Payment System Claims  Rescinded and Replaced by Transmittal 12 382  01/02/2024 13244  07/20/2023 Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Prospective Payment System Claims  SENSITIVE CONTROVERSIAL DO NOT POST  Rescinded and Replaced by Transmittal 12291  01/02/2024 13244 R12106CP  06/29/2023 Corrections to Home Health Processing - Claims with Condition DR or Claims Receiving Admission Source Edits   01/02/2024 13225 R11796CP  01/19/2023 Revisions to Processing of Home Health Disaster Related Claims and Contractor -Initiated Adjustments  04/03/2023 13020 R11644CP  10/13/2022 Home Health Claims -  New Grouper Return Code Edits and Informational Unsolicited Response  04/03/2023 12924 R11634CP  10/06/2022 Home Health Claims - New Grouper Return Code Edits and Informational Unsolicited Response - Rescinded and replaced by transmittal 11644  04/03/2023 12924 R11341CP  04/07/2022 Corrections to Home Health Billing for Denial Notices and Calculation of 60-Day Gaps in Services  10/03/2022 12657  R10987CP  09/10/2021 Home Health Notices of Admission -- Additional Manual Instructions   11/10/2021 12424 R10919CP  08/06/2021 Low Utilization Payment Adjustment (LUPA) Add -on Amounts for Home Health (HH) Occupational Therapy Visits and Corrections to Payment Grouping Processes   01/03/2022 12315 R10839CP   06/09/2021 Replacing Home Health Requests for Anticipated Payment (RAPs) with a Notice of Admission (NOA) -- Manual Instructions   08/11/2021 12256 R10758CP  05/11/2021 Replacing Home Health Requests for Anticipated Payment (RAPs) with a Notice of Admission (NOA) -- Manual Instructions  Rescinded and replaced by transmittal 10839    08/11/2021 12256 R10696CP  03/31/2021 Penalty for Delayed Request for Anticipated Payment (RAP) Submission  Implementation   01/04/2021 11855 R10403CP   10/27/2020 Penalty for Delayed Request for Anticipated Payment (RAP) Submission  Implementation - Rescinded and replaced by transmittal 10696  01/04/2021 11855 R10369CP  09/24/2020 Penalty for Delayed Request for Anticipated Payment (RAP) Submission  Implementation - Rescinded and replaced by transmittal 10403  01/04/2021 11855 R10274CP  08/07/2020 Update to Osteoporosis Drug Codes Billable on Home Health Claims  01/04/2021 11846 R10254CP  07/31/2020 Penalty for Delayed Request for Anticipated Payment (RAP) Submission  Implementation - Rescinded and replaced by transmittal 10369 01/04/2021 11855 R4489CP  01/09/2020 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Split Implementation  07/01/2019 11081 R4482CP  12/20/2020 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Split Implementation -Rescinded and Replaced by Transmittal # 4489  07/01/2019 11081  R4466CP  11/22/2019 Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2020  01/06/2020 11536 R4453CP   11/08/2019 Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2020 -- Rescinded and Replaced by Transmittal # 4466 01/06/2020 11536 R4378CP  08/23/2019 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Revised and Additional Manual Instructions  11/27/2019 11395 R4312CP  05/23/2019 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Additional Manual Instructions  08/16/2019 11272 R4294CP  05/03/2019 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Additional Manual Instructions -- Rescinded and Replaced by Transmittal # 4312 08/07/2019 11272 R4244CP  02/15/2019 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Split Implementation -  Rescinded and Replaced by Transmittal # 4482 07/01/2019 11081 R4228CP  02/01/2019 Home Health (HH) Patient- Driven Groupings Model (PDGM) -  Split Implementation -- Rescinded and Replaced by Transmittal # 4244 07/01/2019 11081 R4210CP  01/25/2019 Update to Pub. 100- 04 Chapter 10 to Provide Language -Only Changes for the New Medicare Card Project  02/26/2019 11077 R4190CP  12/31/2018 Home Health Rural Add -on Payments Based on County of Residence  01/07/2019 10782 R4148CP  10/19/2018        Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2019  01/07/2019 10992 R4106CP  08/03/2018 Home Health Rural Add -on Payments Based on County of Residence - Rescinded and Replaced by Transmittal # 4190 01/07/2019 10782 R3948CP  01/05/2018 Ensuring Correct Processing of Home Health Disaster Related Claims and Claims for Denial  07/02/2018 10372 R3933CP  12/07/2017 Revisions to the Home Health Pricer to Support Value -Based Purchasing and Payment Standardization  01/02/2018 10167 R3888CP  10/20/2017   Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2018  01/02/2018 10310 R3829CP  08/04/2017 Revisions to the Home Health Pricer to Support Value -Based Purchasing and Payment Standardization - Rescinded and Replaced by Transmittal 3933