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Intermittent, if Skilled Nurse

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.1.3)External PDF

  • Intermittent skilled nursing care is a medically predictable, recurring need for skilled nursing services that is provided fewer than seven days each week, or fewer than eight hours each day, for periods of 21 days or less. Additionally, to meet the requirement for “intermittent” skilled nursing care, a patient must have a medically predictable recurring need for skilled nursing services.  In most instances, this definition will be met if a patient requires a skilled nursing service at least once every 60 days.
  • Usually the beneficiary requires skilled nursing services at least once every 60 days. However, in certain situations, (e.g. silicone catheter changes) a beneficiary may require skilled nursing services less often (e.g., every 60–90 days). In these situations, documentation must show a recurring need for reasonable, necessary, and medically predictable skilled nursing services.
  • The intermittent criteria applies only when the beneficiary qualifies for home health benefits on the basis of the need for intermittent skilled nursing services alone, and does not apply when the beneficiary has home health based on the need for physical therapy, speech therapy, or a continued need for occupational therapy.

Reviewed: 12.10.21


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