Reimbursable Home Health Services

The licensed and certified Class A Home Care shall not utilize staff that has been excluded from participation in federally funded health care programs by the US Department of Health and Human Services (HHS)/Office of Inspector General (OIG) and shall be in good standing with the Colorado Department of Regulatory Agencies (DORA) or other regulatory agency:

Registered Nurses (RN) and Licensed Practical Nurses (LPN) must have a current, active license in accordance with the DORA Colorado Nurse Practice Act at §12-38-111, C.R.S..

 Acute Home Health: All nursing services provided during the acute Home Health period shall be billed under revenue code 550. No PAR is required.

 Long-Term Home Health: Nursing services provided during Long-Term Home Health shall be billed using the appropriate revenue codes based on the purpose and complexity of the nursing visit. Standard, infrequent or complicated nursing visits may be billed using revenue code 551. Nursing visits that are uncomplicated in nature or visits that are uncomplicated with frequent revisits completed by the nurse shall be billed using revenue codes 590 and 599).

o Long-Term Home Health nursing visits for the sole purpose of assessing a client may be reimbursed for a limited time when managing, and reporting to the client’s physician on specific conditions and/or symptoms which are not stable. 

Certified Nurse Aides (CNA) must have a current, active license in accordance with the DORA Colorado Nurse Aide Practice Act at §12-38-111, C.R.S. 

 Acute Home Health: Skilled certified nurse aide visits are reimbursed based on the amount of time the CNA is providing skilled care to a client. If a certified nurse aide provides care for at least 15 minutes but not more than 60 minutes, the agency shall bill a basic unit with revenue code 570. For each every additional 30 minutes the certified nurse aide provides hands-on assistance to the client the agency may bill an extended CNA unit with revenue code 572. A unit of time that is less than 15 minutes shall not be reimbursable as a basic unit and at least 15 minutes must elapse before an agency may bill an extended unit. No PAR is required.

 Long-Term Home Health: Skilled certified nurse aide visits are reimbursed based on the amount of time the CNA is providing skilled care to a client. If a certified nurse aide care for at least 15 minutes but not more than 60 minutes, the agency shall bill a basic unit with revenue code 571. For each every additional 30 minutes the certified nurse aide provides hands-on assistance to the client the agency may bill an extended CNA unit with revenue code 579. A unit of time that is less than 15 minutes shall not be reimbursable as a basic unit and at least 15 minutes must elapse before an agency may bill an extended unit.