100-02 Medicare Benefit Policy Manual: Chapter 7 Crosswalk
us-cms-medicare-manuals-pub-100-02-bp102c07crosswalk100-02 Medicare Benefit Policy Manual: Chapter 7 CrosswalkGuidance
Medicare Benefit Policy Manual Chapter 7 - Home Health Services Crosswalk New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 10 HH-201 Home Health Prospective Payment System 7 10.1 HH-201.1 National 60-Day Episode Rate 7 10.2 HH-201.2 Adjustments to the 60-Day Episode Rates 7 10.3 HH-201.3 Continuous 60-Day Episode Recertification 7 10.4 HH-201.4 Counting 60-Day Episodes 7 10.5 HH-201.5 Split Percentage Payment Approach to the 60-Day Episode 7 10.6 HH-201.6 Physician Signature Requirements for the Split Percentage Payments 7 10.7 HH-201.7 Low Utilization Payment Adjustment 7 10.8 HH-201.8 Partial Episode Payment Adjustment 7 10.9 HH-201.9 Significant Change in Condition Payment Adjustment (SCIC) 7 10.10 HH-201.10 Outlier Payments 7 10.11 HH-201.11 Discharge Issues 7 10.12 HH-201.12 Consolidated Billing
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 10.13 HH-201.14 Change of Ownership Relationship to Episodes Under PPS 7 20 A3-3116 HHA-203 Conditions to Be Met for Coverage of Home Health Services 7 20.1 A3-3116.1 HHA-203.1 Reasonable and Necessary Services 7 20.1.1 A3-3116.1A HHA-203.1A Background 7 20.1.2 A3-3113.1B HHA-203.1B Determination of Coverage 7 20.2 A3-3116.2 HHA-203.2 Impact of Other Available Caregivers and Other Available Coverage on Medicare Coverage of Home Health Services 7 20.3 A3-3116.3 HHA-203.3 Use of Utilization Screens and "Rules of Thumb" 7 30 A3-3117 HHA-204 A-98-49 Conditions Patient Must Meet to Qualify for Coverage of Home Health Services 7 30.1 A3-3117.1 HHA-204.1 Confined to the Home 7 30.1.1 A3-3117.1A HHA-204.1A A-01-21 Patient Confined to the Home 7 30.1.2 A3-3117.1B HHA-204.1B Patient's Place of Residence 7 30.2 A3-3117.2 HHA-204.2 Services Are Provided Under a Plan of Care Established and Approved by a Physician 7 30.2.1 A3-3117.2A HHA-204.2A Content of the Plan of Care 7 30.2.2 A3-3117.2B HHA-204.2B Specificity of Orders 7 30.2.3 A3-3117.2C HHA-204-2C Who Signs the Plan of Care
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 30.2.4 A3-3117.2D HHA-204-2D Timeliness of Signature 7 30.2.5 A3-3117.2E HHA-204-2E Use of Oral (Verbal) Orders 7 30.2.6 A3-3117.2F HHA-204.2F Frequency of Review of the Plan of Care 7 30.2.7 A3-3117.2G HHA-204.2G Facsimile Signatures 7 30.2.8 A3-3117.2H HHA-204.2H Alternative Signatures 7 30.2.9 A3-3117.2I HHA-204.2I Termination of the Plan of Care 7 30.2.10 A3-3117.2J HHA-204.2J Sequence of Qualifying Services and Other Medicare Covered Home Health Services 7 30.3 A3-3117.3 HHA-204.3 Under the Care of a Physician 7 30.4 A3-3117.4 HHA-204.4 Needs Skilled Nursing Care on an Intermittent Basis (Other than Solely Venipuncture for the Purposes of Obtaining a Blood Sample), or Physical Therapy or Speech-Language Pathology Services or Has Continued Need for Occupational Therapy 7 30.5 A3-3117.5 HHA-204.5 Physician Certification 7 30.5.1 A3-3117.5A HHA-204.5A Content of the Physician Certification 7 30.5.2 A3-3117.5B HHA-204.5B Periodic Recertification 7 30.5.3 A3-3117.5C HHA-204.5C Who May Sign the Certification
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 40 A3-3118 HHA-205 Covered Services Under a Qualifying Home Health Plan of Care 7 40.1 A3-3118.1 HHA-205.1 Skilled Nursing Care 7 40.1.1 A3-3118.1 HHA-205.1 General Principles Governing Reasonable and Necessary Skilled Nursing Care 7 40.1.2 A3-3118.1B HHA-205.1B Application of the Principles to Skilled Nursing Services 7 40.1.2.1 A3-3118.1B1 HHA-205.1B1 Observation and Assessment of the Patient's Condition When Only the Specialized Skills of a Medical Professional Can Determine Patient's Status 7 40.1.2.2 A3-3118.1B2 HHA-205.1B2 Management and Evaluation of a Patient Care Plan 7 40.1.2.3 A3-3118.1B3 HHA-205.1B3 Teaching and Training Activities 7 40.1.2.4 A3-3118.1B4 HHA-205.1B4 Administration of Medications 7 40.1.2.5 A3-3118.1B5 HHA-205.1B5 Tube Feedings 7 40.1.2.6 A3-4118.1B6 HHA-205.1B6 Nasopharyngeal and Tracheostomy Aspiration 7 40.1.2.7 A3-3118.1B7 HHA-205.1B7 Catheters 7 40.1.2.8 A3-3118.1B8 HHA-205.1B8 Wound Care 7 40.1.2.9 A3-3118.1B9 HHA-205.1B9 Ostomy Care 7 40.1.2.10 A3-3118.1B10 HHA-205.1B10 Heat Treatments 7 40.1.2.11 A3-3118.1B11 HHA-205.1B11 Medical Gasses
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 40.1.2.12 A3-3118.1B12 HHA-205.1B12 Rehabilitation Nursing 7 40.1.2.13 A3-3118.1B13 HHA-205.1B13 Venipuncture 7 40.1.2.14 A3-3118.1B14 HHA-205.1B14 Student Nurse Visits 7 40.1.2.15 A3-3118.1B15 HHA-205.1B15 Psychiatric Evaluation, Therapy, and Teaching 7 40.1.3 A3.3118.1C HHA-205.1C Intermittent Skilled Nursing Care 7 40.2 A3-3118.2 HHA-205.2 Skilled Therapy Services 7 40.2.1 A3-3118.2A HHA-205.2A General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology services, and Occupational Therapy 7 40.2.2 A3-3118.2B HHA-205.2B Application of the Principles to Physical Therapy Services 7 40.2.3 A3-3118.2C HHA-205.2C Application of the General Principles to Speech-Language Pathology Services 7 40.2.4 A3-3118.2D HHA-205.2D Application of the General Principles to Occupational Therapy 7 40.2.4.1 A3-3118.2D1 HHA-205.2D1 Assessment 7 40.2.4.2 A3-3118.2D2 HHA-205.2D2 Planning, Implementing, and Supervision of Therapeutic Programs 7 40.2.4.3 A3-3118.2D3 HHA-205.2D3 Illustration of Covered Services 7 50 A3-3119 HHA-206 Coverage of Other Home Health Services
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 50.1 A3-3119.1 HHA-206.1 Skilled Nursing Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy 7 50.2 A3-3119.2 HHA-206.2 Home Health Aide Services 7 50.3 A3-3119.3 HHA-206.3 Medical Social Services 7 50.4 A3-3119.4 HHA-206.4 Medical Supplies (Except for Drugs and Biologicals) and the Use of Durable Medical Equipment 7 50.4.1 A3-3119.4A HHA-206.4A Medical Supplies 7 50.4.1.1 A3-3119.4A2 HHA-206.4A3, 4, 5 The Law, Routine and Non Routine Medical Supplies, and the Patient's Plan of Care 7 50.4.1.2 A3-3119.4A1 HHA-206.4A.1 Routine Supplies (Nonbillable) 7 50.4.1.3 A3-3119.4A2 HHA-206.4A.2 Nonroutine Supplies (Billable) 7 50.4.2 A3-3119.4B HHA-206.4B Durable Medical Equipment 7 50.5 A3-3119.5 HHA-206.5 Services of Interns and Residents 7 50.6 A3-3119.6 HHA-206.6 Outpatient Services 7 50.7 A3-3119.7 HHA-206.7 Part-Time or Intermittent Home Health Aide and Skilled Nursing Services 7 50.7.1 A3-3119.7A HHA-206.7A Definition of "Part-Time" 7 50.7.2 A3-3119.7B HHA-206.7B Definition of "Intermittent"
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 60 A3-3122 HHA-212 Special Conditions for Coverage of Home Health Services Under Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) 7 60.1 A3-3122.1 HHA-212.1 Post-Institutional Home Health Services Furnished During A Home Health Benefit Period - Beneficiaries Enrolled in Part A and Part B 7 60.2 A3-3122.1 HHA-212.2 Beneficiaries Enrolled in Parts A and B and Meet the Institutional Care Threshold 7 60.3 A3-3122.1 HHA-212.3 Beneficiaries Who Are Enrolled In Part A and Part B, But Do Not Meet Threshold For Post-Institutional Home Health Services 7 60.4 A3-3122.1 HHA-212.4 Beneficiaries Who Are Part A Only Or Part B Only 7 70 A3-3123 HHA-215 Duration of Home Health Services 7 70.1 A3-3123.1 HHA-215.1 Number of Home Health Visits Under Hospital Insurance (Part A) 7 70.2 A3-3123.2 HHA-215.2 Number of Home Health Visits Under Supplementary Medical Insurance (Part B) 7 80 A3-3125 HHA-230A Specific Exclusions From Coverage as Home Health Services 7 80.1 A3-3125A HHA-230A Drugs and Biologicals 7 80.2 A3-3125B HHA-230B Transportation 7 80.3 A3-3125C HHA-230C Services That Would Not Be Covered As Inpatient Services 7 80.4 A3-3125D HHA-230D Housekeeping Services
New Chap. New Sect. Int. Pub. 13 HHA Pub. 11 PMs Description 7 80.5 A3-3125E HHA-230E Services Covered Under End Stage Renal Disease (ESRD) Program 7 80.6 A3-3125F HHA-230F Prosthetic Devices 7 80.7 A3-3125G HHA-230G Medical Social Services Furnished to Family Members 7 80.8 A3-3125H HHA-230H Respiratory Care Services 7 80.9 A3-3125I HHA-230I Dietary and Nutrition Personnel 7 90 A3-3127, A3-3661 HHA-219 Medical and Other Health Services Furnished by Home Health Agencies 7 100 A3-3128 HHA-224 Physician Certification for Medical and Other Health Services Furnished by Home Health Agency 7 110 HHA-201.13 A-01-02 Use of Telehealth in Delivery of Home Health Services
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