Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Home Health, Home Infusion, Hospice)
Home Health Examples of home health care services requiring review include:
skilled home nursing visits, home health aid services, home social
worker visits, physical therapy, occupational therapy, speech
therapy and personal care attendants.
Coverage of services is subject to contract benefits and
limitations.
Services must be skilled versus non-skilled or custodial.
Services must be intermittent and of a medical nature.
Home health care must be ordered in writing by a physician
and performed by a Medicare certified/JCAHO approved home
health agency.
Note: Personal care attendants are not eligible for coverage under
most health plans, with the exception of Public Programs.
Services must be submitted on an 837I claim form. The
appropriate revenue code(s) should be submitted for the services
supplied. Associated HCPCS codes must be submitted on each line
or the line may be denied for additional information.
Home Health revenue code categories are:
055X Home Health (HH) - Skilled Nursing
056X Home Health (HH) - Medical Social Services
057X Home Health (HH) - Aide
058X Home Health (HH) - Other Visits
059X Home Health (HH) - Units of Service
060X Home Health (HH) – Oxygen
Prior authorization is recommended for all members, regardless of
plan. For members who are eligible for elderly waiver services, the
home care agency should coordinate with the member’s care
coordinator for home care services. The authorization number
provided by Blue Cross must be entered in the REF segment on the
electronic 837I.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)
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