Reimbursable Home Health Service Locations

The Home Health program reimburses for skilled nursing, skilled certified nurse aide, physical therapy, occupational therapy, and speech therapy services that are provided on an intermittent or per visit basis to Colorado Medical Assistance Program clients in their place of residence.

Colorado Medical Assistance Program pediatric clients may receive Home Health services outside of their place of residence when: 

 The Home Health services can be provided safely and adequately in a location other than the client’s residence; 

 Home Health service and interventions will be at least equally effective in a location other than the client’s residence; 

 It is clinically appropriate for the Home Health services to be provided in a location other than the client’s residence; 

 It is not primarily for the convenience of the client, client’s family, physician or other care provider; 

 It is not provided in a group home, nursing facility, hospital or other facility; and 

 It is not provided on public school grounds or as a part of an Individualized Education Program. 

Other Billing Information

 The Colorado Medical Assistance Program will reimburse two Home Health staff to care for a client when it is necessary to safely provide client care due to complexity of tasks, client weight, etc. and when it has been prior authorized. 

 Client’s Home Health Medical records must be retained by the agency for at least six (6) years unless State or Medicaid regulations require that the client’s records be maintained for more than six (6) years.

Late Bill Override Date

For electronic claims, a delay reason code must be selected and a date must be noted in the “Claim Notes/LBOD” field.

Valid Delay Reason Codes 

1 Proof of Eligibility Unknown or Unavailable 

3 Authorization Delays 

7 Third Party Processing Delay 

8 Delay in Eligibility Determination 

9 Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules 

11 Other