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Home Health Services and Outpatient Therapy Simultaneously

by • April 2, 2018 • 10 Comments

A question I often receive is does the Medicare program pay for a Medicare beneficiary to receive outpatient therapy services while they are simultaneously receiving home health services under an open home health agency (HHA) plan of care? In this article, I will answer this question plus provide resources for the outpatient therapy provider to determine if the Medicare beneficiary is receiving home health services.

The answer is

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10 thoughts on “Home Health Services and Outpatient Therapy Simultaneously”

  1. Michael Diersing says:

    Can you define “Outpatient Therapy Services”? I understand this may sound like a basic question however some OP services are not subject to the same perspective payment system of HH is my understanding.

    1. Rick Gawenda says:

      On claims submitted by providers using the institutional claim format, CWF enforces consolidated billing for outpatient therapies by recognizing as therapies all services billed under revenue codes 042x, 043x, 044x. These revenue codes are subject to consolidated billing when submitted on types of bill 013x, 023x, 034x, 074x, 075x or 085x. Consolidated billing edits do not apply on TOB 034x when the HHA is billing for disposable negative pressure wound therapy services during a HH episode.

      On claims submitted by practitioners using the professional claim format, CWF enforces consolidated billing for outpatient therapies using a list of HCPCS codes which represent therapy services.

  2. Shilo Biegel says:

    Are there any exceptions for a specialized service like powered wheelchair evaluation or a modified barium swallow study?

    1. Rick Gawenda says:

      No!

  3. Craig Smith says:

    What if a patient is receiving Home Health IV treatments only and the Physician orders OP Aquatic PT – can the patient attend aquatic therapy in this scenario?

    1. Rick Gawenda says:

      No!

  4. Matt Sturgis says:

    If outpatient therapy is seeing a patient, say for several weeks and then the pt is opened up by a HHA, does therapy have priority so to speak or does the HHA get reimbursed from that point forward and not the outpatient therapy.

    1. Rick Gawenda says:

      The home health agency takes priority.

  5. Ashley Kelley says:

    Do Medicare replacement plans also apply in this situation or only straight Medicare?

    1. Rick Gawenda says:

      The article is written on for traditional Medicare. You would have to check with the specific Medicare Advantage plan to see if they pay for outpatient therapy services at the same time the patient is receiving home health services.

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