This home health billing cheat sheet puts the Medicare basics a new biller or agency owner looks up most on one page: the order of submissions, the deadlines, the codes, a check to run before each claim, and where CMS keeps its home health billing guidelines. Each rule links to its Medicare source. It is general education about Original Medicare.
What is the home health billing sequence?
An agency sends one notice of admission for each admission, then one claim for each 30-day period of care until discharge. A claim sent before Medicare has the notice of admission is returned to the provider (Claims Processing Manual, chapter 10, sections 10.1.10.3, 10.1.10.4, 10.1.11, 40.1 and 40.2).
| Step | Type of bill | When | What it needs |
|---|---|---|---|
| Eligibility check | None | Immediately before admission | Confirms the Medicare number is active. CMS suggests it to catch a changed number before the notice goes out. |
| Notice of admission | 032A | Accepted within 5 calendar days after the start of care | A verbal or written order covering the initial visit, and that visit made. The From and Through dates both equal the first visit. |
| Period claim | 0329 | After the 30-day period ends, or after discharge if earlier | All services for the period given, the plan of care and later verbal orders signed, and an accepted OASIS. |
| Adjustment | 0327 | After the original claim pays, within the timely filing period | Corrects information that may change payment, including added visits. |
| Claim cancel | 0328 | When the Medicare number or provider number was wrong | Cancels the claim. The period must then be billed again to be paid. |
| Notice cancel | 032D | When a notice of admission must be withdrawn | Deletes the admission record from Medicare's system. |
Late charge bills (frequency code 5) are not accepted; visits added to a paid period go on a 0327. A transfer from another agency is flagged with condition code 47 on the notice of admission, and after a discharge a new notice of admission is needed before more claims (chapter 10, sections 10.1.10.3, 10.1.13 and 40.2). The notice of admission guide covers the 5-day rule in detail.
What are the home health billing deadlines?
| Item | Deadline | Source |
|---|---|---|
| Initial assessment visit | Within 48 hours of referral or of the patient's return home, or on the ordered start of care date | 42 CFR 484.55(a) |
| Comprehensive assessment (OASIS) at start of care | No later than 5 calendar days after the start of care | 42 CFR 484.55(b)(1) |
| Notice of admission | Submitted to and accepted by the MAC within 5 calendar days after the start of care | 42 CFR 484.205(j); chapter 10, section 10.1.10.3 |
| Face-to-face encounter | No more than 90 days before or within 30 days after the start of care, related to the primary reason for home health. The certifying practitioner documents its date. | 42 CFR 424.22(a)(1)(v); Benefit Policy Manual, chapter 7, section 30.5.1.1 |
| OASIS transmission | Within 30 days of completing the assessment | 42 CFR 484.45(a) |
| Recertification assessment | In the last 5 days of every 60 days from the start of care (days 56 to 60 of the first certification) | 42 CFR 484.55(d)(1); chapter 7, section 10.3 |
| Recertification | At least every 60 days while care continues, signed and dated by the physician or allowed practitioner | 42 CFR 424.22(b)(1) |
| Resumption of care assessment | Within 48 hours of return home from a hospital stay of 24 hours or more (other than for diagnostic tests), or on the ordered resumption date | 42 CFR 484.55(d)(2) |
| Period claim | Any time after the Through date: day 30 of the period, or the discharge date | Chapter 10, sections 10.1.10.4 and 40.2 |
| Payment floor | A clean electronic claim can be paid no earlier than the 14th day after receipt; a paper claim no earlier than the 29th | Claims Processing Manual, chapter 1, section 80.2.1.2 |
| Timely filing | 1 calendar year after the date of service. For a claim that spans dates, the Through date counts. | 42 CFR 424.44; chapter 1, sections 70 and 70.1 |
What should you check before sending the period claim?
Run this list against each 0329 before it goes out. Each item comes from chapter 10 (sections 10.1.10.4, 10.1.19 and 40.2) or 42 CFR 424.22.
- The notice of admission for this admission was accepted.
- The OASIS the claim depends on was accepted into iQIES before the claim goes out, as the OASIS Final Validation Report shows. Its reason for assessment (M0100) is 01, 03, 04 or 05.
- Occurrence code 50 carries that assessment's completion date (M0090), and the CMS Certification Number (M0010) and Medicare number (M0063) match the claim.
- The plan of care and every later verbal order are signed.
- The face-to-face encounter is documented, with its date, in the certification.
- Each visit is on its own line with its revenue code, one G-code, the date, 15-minute units and a charge.
- A Q code line (Q5001, Q5002 or Q5009) goes with the first visit, and again with the first visit at any new location.
- There is one 0023 line with one HIPPS code and zero charges.
- The Through date is 29 days after the From date, or the discharge or death date, and the patient status code fits it.
- Value codes 61 and 85 report where care was given.
Which revenue codes do home health visits use?
Each visit is its own line. Units are 15-minute increments, rounded to the nearest increment, and a line over 96 units (24 hours) gets the claim returned (chapter 10, section 40.2).
| Revenue code | Used for |
|---|---|
| 0023 | The HIPPS code line: one per claim, zero charges |
| 042x | Physical therapy |
| 043x | Occupational therapy |
| 044x | Speech-language pathology |
| 055x | Skilled nursing |
| 056x | Medical social services |
| 057x | Home health aide |
How do you read a home health HIPPS code?
The HIPPS code is five characters and names one of 432 payment groups under the Patient-Driven Groupings Model (PDGM). Medicare's Grouper software assigns the code used for payment from claim and OASIS data (chapter 10, sections 10.1.9 and 10.1.10.1; CMS PDGM page).
| Position | Meaning | Values |
|---|---|---|
| 1 | Admission source and timing | 1 community early, 2 institutional early, 3 community late, 4 institutional late |
| 2 | Clinical group | A to L, 12 groups, such as C for wounds and E for musculoskeletal rehabilitation |
| 3 | Functional impairment level | A low, B medium, C high |
| 4 | Comorbidity adjustment | 1 none, 2 low, 3 high |
| 5 | Placeholder | Always 1 |
Chapter 10's example, 4CC11, is a late period with an institutional source, in the wounds group, with high functional impairment and no comorbidity adjustment. The PDGM billing guide explains how each group is assigned and paid.
What is a LUPA?
A low utilization payment adjustment (LUPA) applies when a 30-day period has fewer visits than its payment group's threshold, which is set at the 10th percentile of visits for that group and is never below 2. The period is then paid per visit instead of the period rate, with an add-on when it is the patient's only or first period in a sequence (42 CFR 484.230; chapter 10, section 10.1.17).
Which home health claim codes come up most?
| Code | Where | Meaning |
|---|---|---|
| Condition code 47 | Notice of admission | Transfer from another agency |
| Occurrence code 50 | Claim | Completion date (M0090) of the OASIS used for payment |
| Patient status 30 | Claim | Still a patient at the end of the period |
| Patient status 06 | Claim | Transfer to another agency, or discharge and readmission in the same period: a partial period payment |
| Modifier KX | 0023 line | Asks for an exception to the late notice of admission penalty |
| Condition code 21 | Claim | Billing for a denial notice |
| Value codes 61 and 85 | Claim | Where care was given: CBSA and county |
| Q5001, Q5002, Q5009 | Visit line | Care at home, in assisted living, or in another place |
All of these come from chapter 10 (sections 10.1.13, 10.1.15, 10.1.17, 10.1.19 and 40.2). The home health billing codes guide lists the rest, including G-codes, with sources.
Where are CMS's home health billing guidelines?
CMS's home health billing rules sit in two manuals, two parts of the federal regulations and a few CMS web pages. Some manual sections still describe requests for anticipated payment; notices of admission replaced them for periods beginning on or after January 1, 2022 (42 CFR 484.205(g)(4)).
| Document | What it is for |
|---|---|
| Medicare Claims Processing Manual, chapter 10: Home Health Agency Billing | How to bill: notices of admission, period claims, adjustments, HIPPS, OASIS matching and every claim field (sections 40.1 and 40.2) |
| Medicare Benefit Policy Manual, chapter 7: Home Health Services | What is covered and for whom: homebound status, certification and recertification, the face-to-face encounter and the plan of care |
| Claims Processing Manual, chapter 1: General Billing Requirements | Rules for all Medicare claims, including timely filing (section 70), the payment floor (80.2.1.2) and home health adjustments (130.5) |
| Claims Processing Manual, chapter 25: Completing and Processing the Form CMS-1450 Data Set | The institutional claim form, field by field |
| 42 CFR part 484 | Conditions of Participation, including assessment timing (484.55) and OASIS reporting (484.45), plus payment rules such as the notice of admission (484.205) and LUPA (484.230) |
| 42 CFR 424.22 | Certification and recertification, including the face-to-face encounter |
| 42 CFR 424.44 | Time limits for filing claims |
| Home Health PPS page | CMS's hub for the payment system, with the yearly rules on its regulations and notices page |
| HHA Information Center | CMS's starting page for agencies, linking the manuals, transmittals, regulations and OASIS manuals |
| OASIS User Manuals | The OASIS guidance manual for each assessment item. The OASIS-E2 version took effect April 1, 2026. |
| Who are the MACs | Which Medicare Administrative Contractor (MAC) processes your claims. Four MACs process home health claims. |
Home health claims from California go to Jurisdiction 6, held by National Government Services, which has operated as Wellpoint Federal since April 2026. CGS (Jurisdiction 15) and Palmetto GBA (Jurisdiction M) run home health pages for their regions.
What are common first-year home health billing mistakes?
- Sending the notice of admission late, or never confirming it was accepted. The period payment is cut by 1/30 for each day from the start of care until the notice is filed, and the patient cannot be billed for it (42 CFR 484.205(j)(3)).
- Sending a claim before its OASIS is accepted in iQIES, which gets the claim returned (chapter 10, section 10.1.19).
- Putting a new Medicare number on the claim while the OASIS still has the old one (section 10.1.19).
- Billing before the plan of care and verbal orders are signed (section 10.1.10.4).
- A face-to-face encounter outside the 90-day or 30-day window, or not related to the primary reason for care (42 CFR 424.22).
- Using a 0328 cancel when a 0327 adjustment would do (section 10.1.11).
- Letting a returned claim sit until the 1-year filing limit passes (42 CFR 424.44).
For how to fix a returned claim, see why home health claims come back.
Related guides
See Medicare home health billing for the full billing cycle, home health billing codes for every code on the claim, and the home health notice of admission for the 5-day rule and late penalty. Why home health claims come back covers returns and reason codes, and billing for a new home health agency covers the path from license to first Medicare claim. If you are weighing outside help, read choosing a home health billing company and outsourced home health billing. For what LMNS covers, see home health billing services.