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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)External Website 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 1External PDF, 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
29 – Date outpatient physical therapy (PT) plan established or last reviewed
30 – Date outpatient speech-language pathology (SLP) plan established or last reviewed
35 – Date treatment started for PT
44 – Date treatment started for OT
45 – Date treatment started for SLP

REV

Report the appropriate revenue code(s):

042X – Physical therapy
043X – Occupational therapy
044X – Speech-language pathology

’X’ represents 0-9; see the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications ManualExternal Website for a complete list of revenue codes.

HCPC

Report the appropriate HCPCS code(s) for the therapy services provided.

Refer to the Annual Therapy UpdateExternal Website for more information.

MODIFS

Report the appropriate therapy modifier with the HCPCS code(s):

GN – Services personally provided by a speech-language therapist
GO – Services personally provided by an occupational therapist
GP – Services personally provided by a physical therapist
KX – Medically necessary outpatient therapy services over the KX modifier threshold amount

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
Required

Report the national provider identifier (NPI) of the physician certifying the therapy plan of care.

L
Required

Report the last name of the physician certifying the therapy plan of care.

F
Required

Report the first name of the physician certifying the therapy plan of care.

M
Optional

Report the middle initial of the physician certifying the therapy plan of care.

REF PHYS NPI
Conditionally Required

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
Conditionally Required

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
Conditionally Required

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
Optional

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

Updated: 05.17.24

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