Services to Include on the Claim for Home Health Benefits
Effective for all services provided on or after October 1, 2000, all services under the home health plan of care, except the following are included in the home health PPS payment amount. Services that may be included in the plan of care but excluded from the HH prospective payment system (HH PPS) are:
* Osteoporosis drugs (although the cost of administration is within the PPS rate); and
* Durable medical equipment, including prosthetics, orthotics, and oxygen
The DMEPOS services may be included on the bill type 32X for the home health benefits, and are paid in addition to the PPS payment. See §20 for additional instructions regarding competitively bid DME. Osteoporosis drugs must be billed on bill type 34X.
Other services not under an HH plan of care provided by an HHA are billed using type of bill 34X. Such services not under a plan of care, and services not part of the home health benefit, are often referred to as “Part B and other health services.” See §90 for guidance as to the payment methodologies used by Medicare to reimburse these services, and see §40.4 in this chapter for information on deductible and coinsurance. Physical therapy, occupational therapy and speech language pathology services not delivered under an HH plan of care (optional Form CMS-485), are paid under the Medicare Physician Fee Schedule (See Chapter 5.) Such services must be delivered under other plans of care
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