Home Health Outpatient Therapy Billing
A home health agency (HHA) may furnish outpatient therapy services to individuals who are not homebound or otherwise not receiving services under a home health plan of care (POC). Payment for outpatient therapy services is calculated using the Medicare Physician Fee Schedule (MPFS) rather than the Home Health Prospective Payment System (HH PPS).
The table below provides additional information required for HHA outpatient therapy claims.
Field Name | Description |
---|---|
TOB |
34X – HHA visits provided on an outpatient basis 'X' represents the bill frequency; see the Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 80.3.2.2. |
OCC CDS/DATES |
11 – Onset of symptoms/illness and date Report any appropriate occurrence code(s) and date: 17 – Date outpatient occupational therapy (OT) plan established or last reviewed |
REV |
Report the appropriate revenue code(s): |
HCPC |
Report the appropriate HCPCS code(s) for the therapy services provided. Refer to the Annual Therapy Update for more information. |
MODIFS |
Report the appropriate therapy modifier with the HCPCS code(s): GN – Services personally provided by a speech-language therapist |
TOT UNIT |
Report the number of times the procedure was performed. |
COV Unit |
Report the number of covered service units for the therapy service billed. |
TOT CHARGE |
Report the total charge per revenue code. |
SERV DATE |
Report the line-item date of service. |
ATT PHYS NPI |
Report the national provider identifier (NPI) of the physician certifying the therapy plan of care. |
L |
Report the last name of the physician certifying the therapy plan of care. |
F |
Report the first name of the physician certifying the therapy plan of care. |
M |
Report the middle initial of the physician certifying the therapy plan of care. |
REF PHYS NPI |
Report the NPI of the physician certifying the therapy plan of care only if different professionals certify the occupational therapy (OT), physical therapy (PT), or speech-language pathology (SLP) plan of care. |
L |
Report the last name of the physician certifying the therapy plan of care only if different professionals certify the OT, PT, or SLP plan of care. |
F |
Report the first name of the physician certifying the therapy plan of care only if different professionals certify the OT, PT, or SLP plan of care. |
M |
Report the middle initial of the physician certifying the therapy plan of care only if different professionals certify the OT, PT, or SLP plan of care. |
Additional Resources
- Annual Therapy Update
- Home Health Outpatient Therapies Coverage Guidelines
- Medicare Benefit Policy Manual (Pub. 100-02, Ch. 15)
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 5)
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 10)
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 25)
- Therapy Services
Updated: 05.17.24